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Use of levosimendan in myocardial dysfunction due to sepsis
Critical Care volume 13, Article number: P165 (2009)
Myocardial dysfunction observed within the context of sepsis is partially due to desensitization of the cardiac muscle to vasoactive agents. Levosimendan, a calcium sensitizer and a K+-ATP channel opener, plays a significant role in the treatment of myocardial depression although its use in sepsis has not yet been established.
We studied 42 patients (66.1 ± 7.54 years, 24 male) who met the criteria for sepsis (infection by Gram-negative bacteria and at least two SIRS criteria) and displayed severe heart dysfunction (cardiac index (CI) ≤ 2.2, ejection fraction (EF) ≤ 35%). The APACHE II score was 21.2 ± 4.9. Patients were randomized to receive additionally to their standard treatment levosimendan (0.1 μg/kg/minute 24-hour infusion) (group A, n = 23) without loading dose or dobutamine (5 to 10 μg/kg/minute 24-hour infusion) (group B, n = 19). Noradrenaline was used to preserve the mean arterial pressure above 65 mmHg. The primary goal was mortality at 7 and 30 days.
Mortality at 7 and 30 days was 30% and 60% in group A versus 36% and 68% in group B (P = 0.05, P = 0.03, respectively). The CI and EF significantly increased in group A (ΔCI: 1.79 ± 0.16 vs. 1.4 ± 0.12, P = 0.027; ΔEF: 4.8 ± 0.2% vs. 3.5 ± 0.7%, P = 0.04), and also SvO2 (P = 0.012) and mean arterial pressure (P = 0.035) were significantly increased.
Levosimendan compared with dobutamine improves the hemodynamic profile of septic patients with myocardial dysfunction; and while there is evidence that it reduces mortality, further studies are needed to verify this.
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Vaitsis, J., Michalopoulou, H., Thomopoulos, C. et al. Use of levosimendan in myocardial dysfunction due to sepsis. Crit Care 13, P165 (2009). https://doi.org/10.1186/cc7329
- Ejection Fraction
- Arterial Pressure
- Cardiac Index
- Channel Opener