Effects of resuscitation with sodium bicarbonate on cardiac function in patients with early-phase septic shock

Fang, Zhi Xun

doi:10.1186/isrctn36748319

Cited by 5 publications

(12 citation statements)

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“…It is possible that the decrease in CL and Q may have implications in the development of cardiotoxicity, since by having a lower CL performance of DOX, the drug accumulates in cells and can cause cardiac toxicity. This relevance of pharmacological CL in the heart is evidenced by the study reported by Fang, M and Dong, 51 in whose study they found that levosimendan could decrease lactic acid and increase the CL rate of lactate and thus increase cardiac ejection fraction, reduce heart preload, intrathoracic lung water, improve heart function and systemic hemodynamic indices of patients with septic shock. This finding is highly relevant since in the early diagnosis of patients who are administered ACs, special attention is suggested since generally diastolic dysfunction is a precursor and occurs before systolic dysfunction (LVEF and SF).…”

Section: Discussionmentioning

confidence: 83%

Impact of single-nucleotide variants and nutritional status on population pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in children with leukemia

Gándara-Mireles

Lares‐Asseff

Espinoza³

et al. 2022

J Oncol Pharm Pract

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Purpose Doxorubicin is an important antineoplastic agent with wide interindividual variability in response to treatment and in its cardiotoxic effects. To determine the effect of genotypic status of three single-nucleotide variants in ABCC1, NCF4, and CBR3 genes and nutritional status assessed by body mass index, on the population pharmacokinetics of Doxorubicin and its cardiotoxic effects in pediatric patients with leukemia. Patients and methods Seventy pediatric patients treated with Doxorubicin were studied, in which 189 biological samples were obtained to determine Doxorubicin concentrations (1 to 3 samples per patient) at different times, for 20 h. Results Low body mass index and age ≤ 7 years were associated with decreased clearance of Doxorubicin, and female gender was associated with increased clearance of Doxorubicin. Low BMI and low height were associated with a decrease and increase, respectively, in the intercompartmental clearance (Q) of Doxorubicin. TT homozygosity of the single-nucleotide variant rs3743527 of the ABCC1 gene was associated with an increase in clearance and decreased area under the curve, AA homozygosity of the single-nucleotide variant rs1883112 of the NCF4 gene was associated with a decrease in the volume of distribution in the peripheral compartment (V2), and GG homozygosity of CBR3 rs1056892 with increasing area under the curve. Conclusion Some covariates studied are directly related to the increase or decrease of the pharmacokinetic parameters of Doxorubicin. Decreased clearance, V2, and increased area under the curve were associated with systolic dysfunction, and decreased Q and V2 were associated with diastolic dysfunction. These results may contribute to the effective and safe use of Doxorubicin in pediatric patients with leukemia.

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Section: Discussionmentioning

confidence: 83%

Impact of single-nucleotide variants and nutritional status on population pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in children with leukemia

Gándara-Mireles

Lares‐Asseff

Espinoza³

et al. 2022

J Oncol Pharm Pract

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“…The characteristics of all included studies are summarized in Table 1. The control group treatments varied, including placebo, 38,39,49,61,63,64,69,71,72,74,75,77,81,83,84,[87][88][89][90][91][92][93]96,97,104 dobutamine, 33,40,46,48,50,52,54,[56][57][58][59][60]62,65,68,73,76,80,82,85,86,95,[98][99][100][101][102]…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Four studies 40,62,79,89 with 139 patients were included. Fixed effects model meta-analysis results showed that levosimendan reduced the LVEDVI [SMD = À1.24, 95% CI (À1.61, À0.86), P < 0.00001] (Figure 3B).…”

Section: Left Ventricular End-diastolic Volume Indexmentioning

confidence: 99%

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Effect of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction: a meta‐analysis

Wang,

Zhao,

Wang

et al. 2024

ESC Heart Failure

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Heart failure is the final stage of several cardiovascular diseases, and the key to effectively treating heart failure is to reverse or delay ventricular remodelling. Levosimendan is a novel inotropic and vasodilator agent used in heart failure, whereas the impact of levosimendan on ventricular remodelling is still unclear. This study aims to investigate the impact of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction. Electronic databases were searched to identify eligible studies. A total of 66 randomized controlled trials involving 7968 patients were included. Meta‐analysis results showed that levosimendan increased left ventricular ejection fraction [mean difference (MD) = 3.62, 95% confidence interval (CI) (2.88, 4.35), P < 0.00001] and stroke volume [MD = 6.59, 95% CI (3.22, 9.96), P = 0.0001] and significantly reduced left ventricular end‐systolic volume [standard mean difference (SMD) = −0.52, 95% CI (−0.67, −0.37), P < 0.00001], left ventricular end‐diastolic volume index [SMD = −1.24, 95% CI (−1.61, −0.86), P < 0.00001], and left ventricular end‐systolic volume index [SMD = −1.06, 95% CI (−1.43, −0.70), P < 0.00001]. In terms of biomarkers, levosimendan significantly reduced the level of brain natriuretic peptide [SMD = −1.08, 95% CI (−1.60, −0.56), P < 0.0001], N‐terminal pro‐brain natriuretic peptide [SMD = −0.99, 95% CI (−1.41, −0.56), P < 0.00001], and interleukin‐6 [SMD = −0.61, 95% CI (−0.86, −0.35), P < 0.00001]. Meanwhile, levosimendan may increase the incidence of hypotension [risk ratio (RR) = 1.24, 95% CI (1.12, 1.39), P < 0.0001], hypokalaemia [RR = 1.57, 95% CI (1.08, 2.28), P = 0.02], headache [RR = 1.89, 95% CI (1.50, 2.39), P < 0.00001], atrial fibrillation [RR = 1.31, 95% CI (1.12, 1.52), P = 0.0005], and premature ventricular complexes [RR = 1.86, 95% CI (1.27, 2.72), P = 0.001]. In addition, levosimendan reduced all‐cause mortality [RR = 0.83, 95% CI (0.74, 0.94), P = 0.002]. In conclusion, our study found that levosimendan might reverse ventricular remodelling when applied in patients with left ventricular systolic dysfunction, especially in patients undergoing cardiac surgery, decompensated heart failure, and septic shock.

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“…For example, the inflammatory factor storm in patients with sepsis is systemic, and various organs may be damaged. Although levosimendan has potential anti-inflammatory and anti-apoptotic effects, its efficacy or its leading role may not be well exerted [14,15].…”

Section: Discussionmentioning

confidence: 99%

The association between levosimendan and mortality in patients with sepsis or septic shock: a systematic review and meta-analysis

Ge,

Gao,

et al. 2023

European Journal of Emergency Medicine

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Background Levosimendan is increasingly being used in patients with sepsis or septic shock because of its potential to improve organ function and reduce mortality. We aimed to determine if levosimendan can reduce mortality in patients with sepsis or septic shock via meta-analysis. Evidence sources and study selection We comprehensively searched the PubMed, Embase, Web of Science, and Cochrane Library databases from inception through 1 October 2022. Literature evaluating the efficacy of levosimendan in patients with sepsis or septic shock was included. Data extraction and outcome measurements Two reviewers extracted data and assessed study quality. A meta-analysis was performed to calculate an odds ratio (OR), 95% confidence intervals (CI), and P-values for 28-day mortality (primary outcome). Secondary outcomes included changes in indexes reflecting cardiac function before and after treatment, changes in serum lactate levels in the first 24 h of treatment, and the mean SOFA score during the study period. Safety outcomes included rates of tachyarrhythmias and total adverse reactions encountered with levosimendan. Results Eleven randomized controlled trials were identified, encompassing a total of 1044 patients. After using levosimendan, there was no statistical difference between groups for 28-day mortality (34.9% and 36.2%; OR: 0.93; 95% CI [0.72–1.2]; P = 0.57; I2 = 0%; trial sequential analysis-adjusted CI [0.6–1.42]) and sequential organ failure assessment (SOFA) score, and more adverse reactions seemed to occur in the levosimendan group, although the septic shock patient’s heart function and serum lactate level improved. Conclusion There was no association between the use of levosimendan and 28-day mortality and SOFA scores in patients with septic shock, though there was statistically significant improvement in cardiac function and serum lactate.

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Effects of resuscitation with sodium bicarbonate on cardiac function in patients with early-phase septic shock

Cited by 5 publications

References 0 publications

Impact of single-nucleotide variants and nutritional status on population pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in children with leukemia

Impact of single-nucleotide variants and nutritional status on population pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in children with leukemia

Effect of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction: a meta‐analysis

The association between levosimendan and mortality in patients with sepsis or septic shock: a systematic review and meta-analysis

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