Effects of levosimendan on right ventricular afterload in patients with acute respiratory distress syndrome: a pilot study.

Abstract

OBJECTIVE:

Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS.

DESIGN:

Prospective, randomized, placebo-controlled, pilot study.

SETTING:

Twenty-two-bed multidisciplinary intensive care unit of a university hospital.

PATIENTS:

Thirty-five patients with ARDS in association with septic shock.

INTERVENTIONS:

Patients were randomly allocated to receive a 24-hr infusion of either levosimendan 0.2 microg/kg/min (n = 18) or placebo (n = 17). Data from right heart catheterization, cardiac magnetic resonance, arterial and mixed venous oxygen tensions and saturations, and carbon dioxide tensions were obtained before and 24 hrs after drug infusion.

MEASUREMENTS AND MAIN RESULTS:

At a mean arterial pressure between 70 and 80 mm Hg (sustained with norepinephrine infusion), levosimendan increased cardiac index (from 3.8 +/- 1.1 to 4.2 +/- 1.0 L/min/m) and decreased mean pulmonary artery pressure (from 29 +/- 3 to 25 +/- 3 mm Hg) and pulmonary vascular resistance index (from 290 +/- 77 to 213 +/- 50 dynes/s/cm(5)/m(2); each p < .05). Levosimendan also decreased right ventricular end-systolic volume and increased right ventricular ejection fraction (p < .05). In addition, levosimendan increased mixed venous oxygen saturation (from 63 +/- 8 to 70 +/- 8%; p < .01).

CONCLUSIONS:

This study provides evidence that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS. A large multiple-center trial is needed to investigate whether levosimendan is able to improve the overall prognosis of patients with sepsis and ARDS.

• Authors: Andrea Morelli, Jean-Louis Teboul, Salvatore Maurizio Maggiore, Antoine Vieillard-Baron, Monica Rocco, Giorgio Conti, Andrea De Gaetano, Umberto Picchini, Alessandra Orecchioni, Iacopo Carbone, Luigi Tritapepe, Paolo Pietropaoli, Martin Westphal
• Journal: Critical care medicine (Crit Care Med) Vol. 34 Issue 9 Pg. 2287-93 (Sep 2006) ISSN: 0090-3493 [Print] United States
• PMID: 16791109 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Comment)

Chemical References

• Hydrazones
• Pyridazines
• Vasodilator Agents
• Simendan
• Oxygen

Topics

• Aged
• Female
• Humans
• Hydrazones (therapeutic use)
• Hypertension, Pulmonary (drug therapy, physiopathology)
• Infusions, Intravenous
• Male
• Oxygen (blood)
• Pilot Projects
• Prospective Studies
• Pyridazines (therapeutic use)
• Respiratory Distress Syndrome (drug therapy, physiopathology)
• Shock, Septic (drug therapy, physiopathology)
• Simendan
• Stroke Volume (drug effects, physiology)
• Systole (drug effects, physiology)
• Vascular Resistance (drug effects, physiology)
• Vasodilator Agents (therapeutic use)
• Ventricular Dysfunction, Right (drug therapy, physiopathology)