Skip to content

Advertisement

  • Meeting abstract
  • Open Access

Is it possible to use levosimedan to treat cardiovascular dysfunction in septic patients?

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20037 (Suppl 3) :P37

https://doi.org/10.1186/cc2233

  • Published:

Keywords

  • Cardiomyopathy
  • Septic Shock
  • Vascular Smooth Muscle Cell
  • Septic Patient
  • Bolus Dose

Introduction

Cardiovascular dysfunction (CD) occurs frequently among patients with septic shock and it is more severe in the first 3 days, relapsing at the end of the first week among those who survive. Fifteen percent of the patients with septic shock, who evolve to death, die as a result of CD, whose physiopathologic mechanisms are not fully understood. Levosimedan (LEVO), a new inotropic drug which acts as calcium sensitizing agent and also has effects on potassium channels in vascular smooth muscle cells leading to vasodilatation action, has shown benefits in patients with cardiac failure. An experimental study on the endotoxic shock model has shown improvement on cardiac output, and systemic and regional oxygenation. The aim of this study is to prove the acute hemodynamic effects of LEVO administration on septic patients with severe CD.

Materials and methods

SLS, 70 years old, male, with a history of ischemic cardiomyopathy was admitted with pulmonary infection sepsis and multiple organ dysfunction. The patient received LEVO without bolus dose at an initial rate of 0.1 μg/kg/min in the first hour, followed by 0.2 μg/kg/min during the next 24 hours, monitored with a pulmonary arterial catheter during the observation.

Results

The main hemodynamic and metabolic data are shown in Table 1.

Table 1

 

Baseline*

18 h of treatment#

After 1 h EVO**

After 3 h EVO##

12 h with EVO

24 h with LEVO##

Without LEVO 2 h

Without LEVO 12 h

Without LEVO 24 h

Without LEVO 48 h

CI

1.4

2.8

2.8

3.3

3.2

4.2

3.6

3.6

3.7

4.4

MAP

73

92

78

70

70

66

73

88

79

93

PAOP

22

21

16

21

14

20

20

22

21

22

SVO2

68

75

78

79

75

74

74

75

73

77

VO2

85

90

94

102

111

123

122

119

143

121

Lactate

7.43

5.21

2.55

1.77

1.55

1.77

1.55

1.55

1.54

1.91

Hemodynamic support: * 0.6 μg/kg/min noradrenalin + 20 μg/kg/min dobutamine. # 30 μg/kg/min dobutamine + 5 l Ringer's solution + 500 ml hydroxyethylstarch (HES) (200/0.5). ** 20 μg/kg/min dobutamine + 0.1 μg/kg/min levosimedan (LEVO). ## 0.2 μg/kg/min LEVO + 500 ml HES (200/0.5).

Conclusion

The administration of LEVO in patients with sepsis and septic shock and severe CD has proved to be safe, with immediate improvement of hemodynamic and metabolic parameters that was maintained after discontinuation of the drug. It is necessary that a randomized, controlled trial be done to compare the use of LEVO and other inotropic drugs in the treatment of CD associated with sepsis in order to validate this new indication for the drug.

Authors’ Affiliations

(1)
Hospital do Servidor Público Estadual, São Paulo, SP, Brazil

Copyright

© BioMed Central Ltd 2003

Advertisement