Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock

Hajjej, Zied; Meddeb, B.; Sellami, W.; Labbène, Iheb; Morelli, Andrea; Ferjani, Mustapha

doi:10.1097/shk.0000000000000851

Cited by 29 publications

(21 citation statements)

References 32 publications

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“…[ 2 , 31 ] As there is no proven treatment for SIMD, further study is needed to investigate the efficacy of levosimendan or mechanical support with extracorporeal membrane oxygenation. [ 32 ] A meta-analysis reported that levosimendan reduced mortality compared to standard inotropic therapy possibly because it does not stimulate β-adrenergic receptor. [ 33 ] In SICMP, supportive care is a crucial strategy during the acute phase.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock

et al. 2018

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While both sepsis-induced myocardial dysfunction (SIMD) and stress-induced cardiomyopathy (SICMP) are common in patients with sepsis, the pathogenesis of the 2 diseases is different, and they require different treatment strategies. Thus, we aimed to investigate risk factors and outcomes between the 2 diseases.This retrospective study enrolled patients diagnosed with sepsis or septic shock, admitted to intensive care unit via emergency department in Korea University Anam Hospital, and who underwent transthoracic echocardiography within the first 24 hours of admission.In all, 25 patients with SIMD and 27 patients with SICMP were enrolled. Chronic obstructive pulmonary disease and a history of heart failure (HF) were more prevalent in both the SIMD and SICMP groups than in the control group. In the SIMD and SICMP groups, levels of inflammatory cytokines were similar. Serum troponin level was significantly elevated in the SICMP and SIMD group compared to the control group. N-terminal pro-brain natriuretic peptide (NT pro-BNP) level was significantly elevated in the SIMD group compared to the SICMP group or control group. The in-hospital mortality rate in the SIMD and SICMP group was about 40%, showing increased trends compared with the control group. The in-hospital mortality rate was significantly increased in SIMD group with EF<30% than in SICMP group with EF<30%. In multiple logistic regression analysis, a past history of diabetes mellitus (DM) and HF was significantly associated with the incidence of SIMD. Younger age, elevated levels of NT pro-BNP, and positive result of blood culture also showed significant odds ratio regard to the occurrence of SIMD. However, only elevated lactate and troponin level were positively associated with the incidence of SICMP.The SIMD and SICMP had different risk factors. The risk factors of SIMD were younger age, history of DM, history of HF, elevated NT pro-BNP, and positive result of blood culture. The elevated levels of lactate and troponin were identified as risk factors of SICMP. More importantly, in-hospital mortality rate from SIMD and SICMP showed increased trend and worse outcome in SIMD group with reduced EF<30%. Thus, developing SIMD or SICMP reflected poor prognosis in sepsis or septic shock.

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Section: Discussionmentioning

confidence: 99%

Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock

et al. 2018

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“…Levosimendan is a calcium-sensitising drug that has multiple effects aside from positive inotropy, which are potentially beneficial in sepsis. For example, in a recent pilot randomised controlled trial in 20 patients, levosimendan lowered the lactate/pyruvate ratio, which suggests beneficial effect on cellular metabolic alterations in septic shock (42). However, a large superiority trial that tested the hypothesis that levosimendan would reduce the severity of organ dysfunction in adults with sepsis, in 516 adult patients with sepsis, levosimendan compared to placebo was not associated with less severe organ dysfunction or lower mortality.…”

Section: Vasopressors and Inotropic Agentsmentioning

confidence: 99%

Septic shock resuscitation in the first hour

Simpson

Lamontagne

Shankar-Hari

2017

Current Opinion in Critical Care

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Though the early resuscitation of sepsis and septic shock is key to improving outcomes, ideal resuscitation targets are elusive. Distinction should be drawn between microcirculatory and macrocirculatory changes, and corresponding targets. Common components of resuscitation bundles such as large volume resuscitation and high-dose vasopressors may not be universally beneficial. Microcirculatory targets, individualized resuscitation goals, and reassessment of completed trials using the updated septic shock criteria should be focus areas for future research.

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“…In an updated meta‐analysis comprising five trials,20, 21, 22, 23, 24 we found no statistically significant difference in short‐term mortality in patients with septic shock treated with dobutamine vs. levosimendan (Fig. 2, Fig.…”

Section: Resultsmentioning

confidence: 92%

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Møller

Granholm

Junttila

et al. 2018

Acta Anaesthesiol Scand

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BackgroundAdult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient‐important treatment recommendations on this topic.MethodsThis guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient‐important outcome measures, including mortality and serious adverse reactions.ResultsFor all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions.ConclusionsWe suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.

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Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock

Cited by 29 publications

References 32 publications

Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock

Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock

Septic shock resuscitation in the first hour

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

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