Simendan in these patients is associated with a better postoperative function [1]. A recent study has attributed this phenomenon to preconditioning effects of levosimendan [2]. However, a recent study showed no benefit in starting levosimendan before CPB [3]. We hypothesized that admitting the patient to intensive care 24 hours before CPB and starting levosimendan preoperatively could reduce postoperative cardiac damage. Methods Fifty patients with an ejection fraction less than 30 scheduled for elective cardiac surgery with CPB received anesthesia with propofol, cisatracurium and sufentanil. The patients were randomly assigned to two protocols. Group A: levosimendan 0.1 g/kg/minute started before CPB after induction + dobutamineAvailable online http://ccforum.com/supplements/13/SConclusions In our case series, addition of levosimendan following ineffective conventional therapy resulted in substantial hemodynamic improvement. These preliminary results support the use of levosimendan in patients with LCO as a rescue medication with favorable short-term effects. Reference 1. Raja SG, et al.: Ann Thorac Surg 2006, 81:1536.P169 Effects of levosimendan and inhaled nitric oxide on microcirculation in septic shockA Morelli1, A Donati2, C Ertmer3, S Rehberg3, B Bollen Pinto3, A Orecchioni1, H Van Aken3, P Pelaia2, P Pietropaoli1, M Westphal3 1University of Rome, Italy; 2Marche Polytechnique University, Ancona, Italy; 3University of Muenster, Germany Critical Care 2009, 13(Suppl 1):P169 (doi: 10.1186/cc7333) Introduction Microvascular resuscitation is a Lesogaberan crucial therapeutic goal in sepsis. The current study was performed to test the hypothesis that a combination of levosimendan and inhaled nitric oxide (INO) may improve microvascular perfusion in septic shock. Methods After initial hemodynamic stabilization (mean arterial pressure between 65 and 75 mmHg; mixed venous oxygen saturation 65 ), seven patients with catecholamine-dependent septic shock received intravenous levosimendan 0.2 g/kg/minute for 24 hours. At the end of the first 24 hours of the study period, inhaled nitric oxide (35 ppm) was added for another 12 hours. PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/12083739 Sublingual microvascular perfusion was analyzed using the sidestream dark field method. The total vessel density (mm/mm2), perfused vessel density (mm/mm2), De Backer score (1/mm), microcirculatory flow index of small vessels (MFIs) and microcirculatory flow index of medium vessels (MFIm) were obtained at baseline and after 24 and 36 hours. Results Levosimendan significantly (P <0.05 vs. baseline) increased perfused vessel density from 11.3 mm/mm2 (10.7; 12.6) to 14.8 mm/mm2 (13.7; 16.1) and MFIs from 2 (1.9; 2.2) to 3 (2.8; 3). Addition of INO further increased MFIm from 2.6 (2.5; 2.8) to 3 (3; 3). Data are presented as median (25 ; 75 range). No statistically significant differences were found in any of the other investigated parameters. Conclusions The combination of Levosimendan and INO may improve microvascular perfusion in septic shock.onset of septic shock. For each study patient, a control subject from a group of patients with septic shock of an institutional database was matched for Simplified Acute Physiology Score II, baseline creatinine concentration, delay from shock onset, age, and gender. Serum creatinine concentrations were analyzed just before the start of the 24-hour period of levosimendan infusion (baseline) and 96 hours after levosimendan had been initiated. The glomerular filtration rate was estimated by.
Simendan in these patients is associated with a better postoperative function
por Lizette Kavel (2022-06-21)
Simendan in these patients is associated with a better postoperative function [1]. A recent study has attributed this phenomenon to preconditioning effects of levosimendan [2]. However, a recent study showed no benefit in starting levosimendan before CPB [3]. We hypothesized that admitting the patient to intensive care 24 hours before CPB and starting levosimendan preoperatively could reduce postoperative cardiac damage. Methods Fifty patients with an ejection fraction less than 30 scheduled for elective cardiac surgery with CPB received anesthesia with propofol, cisatracurium and sufentanil. The patients were randomly assigned to two protocols. Group A: levosimendan 0.1 g/kg/minute started before CPB after induction + dobutamineAvailable online http://ccforum.com/supplements/13/SConclusions In our case series, addition of levosimendan following ineffective conventional therapy resulted in substantial hemodynamic improvement. These preliminary results support the use of levosimendan in patients with LCO as a rescue medication with favorable short-term effects. Reference 1. Raja SG, et al.: Ann Thorac Surg 2006, 81:1536.P169 Effects of levosimendan and inhaled nitric oxide on microcirculation in septic shockA Morelli1, A Donati2, C Ertmer3, S Rehberg3, B Bollen Pinto3, A Orecchioni1, H Van Aken3, P Pelaia2, P Pietropaoli1, M Westphal3 1University of Rome, Italy; 2Marche Polytechnique University, Ancona, Italy; 3University of Muenster, Germany Critical Care 2009, 13(Suppl 1):P169 (doi: 10.1186/cc7333) Introduction Microvascular resuscitation is a Lesogaberan crucial therapeutic goal in sepsis. The current study was performed to test the hypothesis that a combination of levosimendan and inhaled nitric oxide (INO) may improve microvascular perfusion in septic shock. Methods After initial hemodynamic stabilization (mean arterial pressure between 65 and 75 mmHg; mixed venous oxygen saturation 65 ), seven patients with catecholamine-dependent septic shock received intravenous levosimendan 0.2 g/kg/minute for 24 hours. At the end of the first 24 hours of the study period, inhaled nitric oxide (35 ppm) was added for another 12 hours. PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/12083739 Sublingual microvascular perfusion was analyzed using the sidestream dark field method. The total vessel density (mm/mm2), perfused vessel density (mm/mm2), De Backer score (1/mm), microcirculatory flow index of small vessels (MFIs) and microcirculatory flow index of medium vessels (MFIm) were obtained at baseline and after 24 and 36 hours. Results Levosimendan significantly (P <0.05 vs. baseline) increased perfused vessel density from 11.3 mm/mm2 (10.7; 12.6) to 14.8 mm/mm2 (13.7; 16.1) and MFIs from 2 (1.9; 2.2) to 3 (2.8; 3). Addition of INO further increased MFIm from 2.6 (2.5; 2.8) to 3 (3; 3). Data are presented as median (25 ; 75 range). No statistically significant differences were found in any of the other investigated parameters. Conclusions The combination of Levosimendan and INO may improve microvascular perfusion in septic shock.onset of septic shock. For each study patient, a control subject from a group of patients with septic shock of an institutional database was matched for Simplified Acute Physiology Score II, baseline creatinine concentration, delay from shock onset, age, and gender. Serum creatinine concentrations were analyzed just before the start of the 24-hour period of levosimendan infusion (baseline) and 96 hours after levosimendan had been initiated. The glomerular filtration rate was estimated by.