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Effects of levosimendan and inhaled nitric oxide on microcirculation in septic shock

Introduction

Microvascular resuscitation is a 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 μg/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. Sublingual microvascular perfusion was analyzed using the side-stream 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.

Conclusion

The combination of Levosimendan and INO may improve microvascular perfusion in septic shock.

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Morelli, A., Donati, A., Ertmer, C. et al. Effects of levosimendan and inhaled nitric oxide on microcirculation in septic shock. Crit Care 13, P169 (2009). https://doi.org/10.1186/cc7333

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Keywords

  • Nitric Oxide
  • Septic Shock
  • Levosimendan
  • Vessel Density
  • Microvascular Perfusion