Hemodynamic and volumetric response to levosimendan in critical care patients

Introduction

Levosimendan (LS), a new inodilator, improves survival in patients with congestive heart failure, but data on critical care patients with cardiorespiratory failure are scanty [1]. The aim of this study is to evaluate the homodynamic and volumetric response to LS in critical care patients with cardiogenic shock.

Materials and methods

Ten critical care patients with cardiogenic shock were studied. All patients were mechanically ventilated and connected to an integrated monitoring system (PICCO system/Agilent) by a fiberoptic arterial catheter (pv 2014L16) and by a Swan–Ganz catheter. At basal time (T0) and at 1 hour (T1), 6 hours (T2), 12 hours (T3), 24 hours (T4) during LS infusion and at 12 hours post LS suspension (T5), the main haemodynamic and volumetric data were studied. All data are expressed as mean ± SD. The ANOVA test for RM was used to compare changes during times study.

Results

Table 1 presents the main hemodynamic changes of cardiac output (CO), pulmonary capillary wedge pressure (PCWP), intrathoracic blood volume (ITBVI) and extravascular lung water (EVLWI).

Table 1

Conclusions

(1) LS increases the cardiac index and improves filling pressures in critical care patients. (2) This improvement correlates with decreasing of ITBVI and lung edema. (3) A haemodynamic effect is maintained after LS infusion: this may be useful during rapid weaning from ventilatory support.