Hemodynamic effects of a continuous infusion of levosimendan in critically ill patients with cardiogenic shock requiring catecholamines

被引:70
作者
Delle Karth, G [1 ]
Buberl, A [1 ]
Geppert, A [1 ]
Neunteufl, T [1 ]
Huelsmann, M [1 ]
Kopp, C [1 ]
Nikfardjam, M [1 ]
Berger, R [1 ]
Heinz, G [1 ]
机构
[1] Univ Vienna, Klin Innere Med Kardiol, Dept Cardiol, A-1090 Vienna, Austria
关键词
calcium; cardiogenic shock; inotropic agents; levosimendan;
D O I
10.1046/j.1399-6576.2003.00252.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with decompensated heart failure with preserved arterial blood pressure. Data on its use in patients with cardiogenic shock are rare. The present series describes the 24-h hemodynamic effects of levosimendan as add-on therapy in desperately ill patients with cardiogenic shock requiring catecholamines. Methods: Ten patients with cardiogenic shock received levosimendan as continuous infusion of 0.1 mug kg(-1) min(-1) for 24 h. The patients were otherwise unselected. Hemodynamic measurements were routinely performed at baseline (time 0) and at 1, 8, 16 and 24 h after start of levosimendan (LS) using a Swan-Ganz thermodilution catheter. Results: During the levosimendan infusion there was a significant increase in cardiac index from 1.8+/-0.4 to 2.4+/-0.6 L*min(-1)*m(-2) (P=0.023) and a significant decrease in systemic vascular resistance from 1559+/-430 to 1109+/-202 dyn*s*cm(-5) (P=0.001), respectively. Changes in catecholamine dose, and in systolic and diastolic blood pressure were not significant. Given the individual response to LS, 8/10 patients showed an increase in left ventricular stroke work index under reduced or roughly unchanged preload conditions after 8 h. Conclusion: This series shows that a LS infusion is feasible and able to improve hemodynamics in severely compromized, critically ill patients with cardiogenic shock requiring catecholamine therapy. Its potential advantages when compared with other inotropes are unclear. To clarify the potential role of LS in this clinical setting randomized controlled trials on hemodynamic and mortality endpoints are needed.
引用
收藏
页码:1251 / 1256
页数:6
相关论文
共 18 条
  • [1] CURRENT CONCEPTS - CARDIOGENIC-SHOCK
    CALIFF, RM
    BENGTSON, JR
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1994, 330 (24) : 1724 - 1730
  • [2] L-NMMA (a nitric oxide synthase inhibitor) is effective in the treatment of cardiogenic shock
    Cotter, G
    Kaluski, E
    Blatt, A
    Milovanov, O
    Moshkovitz, Y
    Zaidenstein, R
    Salah, A
    Alon, D
    Michovitz, Y
    Metzger, M
    Vered, Z
    Golik, A
    [J]. CIRCULATION, 2000, 101 (12) : 1358 - 1361
  • [3] Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial
    Follath, F
    Cleland, JGF
    Just, H
    Papp, JGY
    Scholz, H
    Peuhkurinen, K
    Harjola, VP
    Mitrovic, V
    Abdalla, M
    Sandell, EP
    Lehtonen, L
    [J]. LANCET, 2002, 360 (9328) : 196 - 202
  • [4] TROPONIN C-MEDIATED CALCIUM SENSITIZATION BY LEVOSIMENDAN ACCELERATES THE PROPORTIONAL DEVELOPMENT OF ISOMETRIC TENSION
    HAIKALA, H
    LEVIJOKI, J
    LINDEN, IB
    [J]. JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY, 1995, 27 (10) : 2155 - 2165
  • [5] Cardiogenic shock complicating acute coronary syndromes
    Hasdai, D
    Topol, EJ
    Califf, RM
    Berger, PB
    Holmes, DR
    [J]. LANCET, 2000, 356 (9231) : 749 - 756
  • [6] CURRENT SPECTRUM OF CARDIOGENIC-SHOCK AND EFFECT OF EARLY REVASCULARIZATION ON MORTALITY - RESULTS OF AN INTERNATIONAL REGISTRY
    HOCHMAN, JS
    BOLAND, J
    SLEEPER, LA
    PORWAY, M
    BRINKER, J
    COL, J
    JACOBS, A
    SLATER, J
    MILLER, D
    WASSERMAN, H
    MENEGUS, MA
    TALLEY, JD
    MCKINLAY, S
    SANBORN, T
    LEJEMTEL, T
    KOPER, B
    WARWICK, D
    SCHULMAN, S
    COOMBS, V
    RENKIN, J
    LAUWERS, R
    CURRIER, JW
    MAZUR, ME
    PEPE, AJ
    LANG, GR
    ZOLA, BE
    MELLOW, E
    SILVASI, D
    ESCALA, E
    GREENBERG, MA
    MUELLER, HS
    BREITBART, S
    CHARNEY, R
    LEVINE, B
    YUSSMAN, Z
    ETKA, W
    FORMAN, R
    MONRAD, ES
    NANA, M
    STROM, J
    GALVAO, M
    WEINER, B
    GORE, J
    OKIKE, O
    BORBONE, M
    MOSES, JW
    CHARASH, B
    COHEN, N
    MOREYRA, AE
    PALMERI, S
    [J]. CIRCULATION, 1995, 91 (03) : 873 - 881
  • [7] Intracoronary levosimendan enhances contractile function of stunned myocardium
    Jamali, IN
    Kersten, JR
    Pagel, PS
    Hettrick, DA
    Warltier, DC
    [J]. ANESTHESIA AND ANALGESIA, 1997, 85 (01) : 23 - 29
  • [8] Pharmacodynamics and safety of a new calcium sensitizer, levosimendan, and its metabolites during an extended infusion in patients with severe heart failure
    Kivikko, M
    Antila, S
    Eha, J
    Lehtonen, L
    Pentikäinen, PJ
    [J]. JOURNAL OF CLINICAL PHARMACOLOGY, 2002, 42 (01) : 43 - 51
  • [9] Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting
    Lilleberg, J
    Nieminen, MS
    Akkila, J
    Heikkila, L
    Kuitunen, A
    Lehtonen, L
    Verkkala, K
    Mattila, S
    Salmenpera, M
    [J]. EUROPEAN HEART JOURNAL, 1998, 19 (04) : 660 - 668
  • [10] Levosimendan potentiates the inotropic actions of dopamine in conscious dogs
    McGough, MF
    Pagel, PS
    Lowe, D
    Hettrick, DA
    Warltier, DC
    [J]. JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 1996, 28 (01) : 36 - 47