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

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...

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Published in:Acta anaesthesiologica Scandinavica 2003-11, Vol.47 (10), p.1251-1256
Main Authors: Delle Karth, G., Buberl, A., Geppert, A., Neunteufl, T., Huelsmann, M., Kopp, C., Nikfardjam, M., Berger, R., Heinz, G.
Format: Article
Language:English
Subjects:
Aged
Blood Pressure - drug effects
Calcium
Cardiac Output - drug effects
cardiogenic shock
Cardiotonic Agents - administration & dosage
Critical Illness
Dopamine - administration & dosage
Drug Therapy, Combination
Hemodynamics - drug effects
Humans
Hydrazones - administration & dosage
Infusions, Intravenous
inotropic agents
levosimendan
Pyridazines - administration & dosage
Shock, Cardiogenic - drug therapy
Shock, Cardiogenic - physiopathology
Simendan
Vasodilator Agents - administration & dosage
Ventricular Function, Left - drug effects
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Summary: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 µg 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.
ISSN:0001-5172
1399-6576
DOI:10.1046/j.1399-6576.2003.00252.x