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No beneficial effects of levosimendan in acute porcine endotoxaemia.

Chew, Michelle LU ; Hawthorne, W J; Bendall, J; Whereat, S; Huang, S; Ting, I; Simond, D and McLean, A (2011) In Acta Anaesthesiologica Scandinavica 55. p.851-861
Abstract
Background: Levosimendan has been proposed as an attractive alternative to adrenergic agents for the treatment of sepsis-induced heart failure and haemodynamic derangements. Its use in this setting is, however, still not well investigated. The aim of this study was to test the hypothesis that levosimendan is able to attenuate endotoxin-induced pulmonary hypertension and improve myocardial function in a porcine model. The secondary aims were to investigate its effect on renal and liver function, and the plasma cytokine response. Methods: Endotoxaemia was induced in 18 pigs, randomized to placebo and Levosimendan groups. All pigs were fluid resuscitated and Noradrenalin infusion was given according to a predefined protocol. Systemic... (More)
Background: Levosimendan has been proposed as an attractive alternative to adrenergic agents for the treatment of sepsis-induced heart failure and haemodynamic derangements. Its use in this setting is, however, still not well investigated. The aim of this study was to test the hypothesis that levosimendan is able to attenuate endotoxin-induced pulmonary hypertension and improve myocardial function in a porcine model. The secondary aims were to investigate its effect on renal and liver function, and the plasma cytokine response. Methods: Endotoxaemia was induced in 18 pigs, randomized to placebo and Levosimendan groups. All pigs were fluid resuscitated and Noradrenalin infusion was given according to a predefined protocol. Systemic haemodynamics and myocardial function were measured using pulmonary artery catheterization and transthoracic echocardiography. Renal and liver function tests and cytokine concentrations were measured in plasma. Results: Levosimendan did not attenuate endotoxin-induced pulmonary hypertension and did not improve myocardial function. There were no differences in renal or liver function. Increases in arterial lactate and decreases in base excess were observed in the Levosimendan group, as well as significant increases in plasma interleukin (IL)-6 and IL-8. Conclusions: Contrary to our hypothesis, levosimendan given in conjunction with a protocolized vasopressor and fluid resuscitation did not improve cardiac, renal or liver function in this model of acute porcine endotoxaemia. Hyperlactataemia, acidosis and increases in plasma pro-inflammatory cytokines were observed, the mechanisms and implications of which remain unclear. (Less)
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type
Contribution to journal
publication status
published
subject
in
Acta Anaesthesiologica Scandinavica
volume
55
pages
851 - 861
publisher
Wiley-Blackwell
external identifiers
  • wos:000292649500012
  • pmid:21574964
  • scopus:79960377779
ISSN
0001-5172
DOI
10.1111/j.1399-6576.2011.02436.x
language
English
LU publication?
yes
id
08513c01-ae4e-4e12-9fba-0c6a1164e00e (old id 1972548)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21574964?dopt=Abstract
date added to LUP
2011-06-07 19:56:55
date last changed
2017-01-01 07:33:31
@article{08513c01-ae4e-4e12-9fba-0c6a1164e00e,
  abstract     = {Background: Levosimendan has been proposed as an attractive alternative to adrenergic agents for the treatment of sepsis-induced heart failure and haemodynamic derangements. Its use in this setting is, however, still not well investigated. The aim of this study was to test the hypothesis that levosimendan is able to attenuate endotoxin-induced pulmonary hypertension and improve myocardial function in a porcine model. The secondary aims were to investigate its effect on renal and liver function, and the plasma cytokine response. Methods: Endotoxaemia was induced in 18 pigs, randomized to placebo and Levosimendan groups. All pigs were fluid resuscitated and Noradrenalin infusion was given according to a predefined protocol. Systemic haemodynamics and myocardial function were measured using pulmonary artery catheterization and transthoracic echocardiography. Renal and liver function tests and cytokine concentrations were measured in plasma. Results: Levosimendan did not attenuate endotoxin-induced pulmonary hypertension and did not improve myocardial function. There were no differences in renal or liver function. Increases in arterial lactate and decreases in base excess were observed in the Levosimendan group, as well as significant increases in plasma interleukin (IL)-6 and IL-8. Conclusions: Contrary to our hypothesis, levosimendan given in conjunction with a protocolized vasopressor and fluid resuscitation did not improve cardiac, renal or liver function in this model of acute porcine endotoxaemia. Hyperlactataemia, acidosis and increases in plasma pro-inflammatory cytokines were observed, the mechanisms and implications of which remain unclear.},
  author       = {Chew, Michelle and Hawthorne, W J and Bendall, J and Whereat, S and Huang, S and Ting, I and Simond, D and McLean, A},
  issn         = {0001-5172},
  language     = {eng},
  pages        = {851--861},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {No beneficial effects of levosimendan in acute porcine endotoxaemia.},
  url          = {http://dx.doi.org/10.1111/j.1399-6576.2011.02436.x},
  volume       = {55},
  year         = {2011},
}