Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs*

Schwarte, Lothar A.; Picker, O.; Bornstein, Stefan R.; Fournell, A.; Scheeren, Thomas

doi:10.1097/01.ccm.0000150653.89451.6f

Cited by 70 publications

(65 citation statements)

References 53 publications

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“…Moreover in the TEA study [ 15 ] , contrasting our results in earlier studies [ 9,[12][13][14] , restoring preload and thus DO 2 suffi ced to restore splanchnic oxygenation.…”

Section: Discussioncontrasting

confidence: 80%

“…Therefore, we tested the hypothesis that levosimendan increases m HbO 2 and compared its effects to the established inotropes milrinone and dobutamine. In contrast to milrinone (showing no signifi cant regional effects) and dobutamine (marked systemic effects) levosimendan augmented m HbO 2 selectively, that is, at only moderately increased oxygen delivery (DO 2 ) in the uncompromised state [ 15 ] .…”

Section: Effects Of Inodilatorsmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

Fournell

Scheeren

Picker

et al. 2011

Oxygen Transport to Tissue XXXIII

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“…Moreover in the TEA study [ 15 ] , contrasting our results in earlier studies [ 9,[12][13][14] , restoring preload and thus DO 2 suffi ced to restore splanchnic oxygenation.…”

Section: Discussioncontrasting

confidence: 80%

Section: Effects Of Inodilatorsmentioning

confidence: 99%

Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

Fournell

Scheeren

Picker

et al. 2011

Oxygen Transport to Tissue XXXIII

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“…Experimental reports have also observed increased blood flow with levosimendan to various tissues including the gastric mucosa, renal medulla, small intestine, and liver. [25,26] Levosimendan has an active metabolite which has similar hemodynamic effects [10][11][12] and has a long elimination half life of around 70 to 80 hours. [12] This can be an explanation of its positive hemodynamic effects lasted even after the 24-hour infusion, Levosimendan may constitute a cost effective option as it decreases significantly ICU and hospital stay and consequent risk of complications after open-heart surgery in high risk patients with compromised cardiac function.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Prophylactic Use of Levosimendan andMilrinone in Open Heart Surgery With CompromisedVentricular Function–A Comparative Study

Jana¹,

Nayak²,

Biswal³

2016

AIMDR

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Background: Compromised ventricular function complicates the postoperative course after open heart surgery. Incidence of low-output syndrome (LOS) after cardiopulmonary bypass(CPB) is 30%. Vaso active therapy is required for weaning from bypass. Levosimendan is one of the new class of inodilator useful in refractory cardiac failure. Objective: The aim of this randomized control trial is to detect whether prophylactic levosimendan infusion is superior to milrinone in preserving better tissue perfusion, in decreasing complications related to low output syndromes and better hemodynamic control and to evaluate the efficacy of intravenous levosimendan infusion in decreasing the use of high dose of conventional inotropes and consequent prolonged hospitalization in open heart surgery patients with preoperative compromised ventricular function. Methods: Thirty consecutive patients with compromised cardiac function belongs to American Society of Anesthesiologists(ASA) physical status III who underwent open-heart surgery with CBP were randomly divided into two groups. Gr-L received levosimendan (loading dose of 12 μg/kg over 10 mins followed by infusion dose of (0.1 μg/kg /min ) and Gr-M received milrinone loading dose of 50 μg/kg over 10 mins followed by infusion dose of (0.5 μg/kg/ min )after anesthesia induction. Hemodynamic profile, mixed or central venous oxygen saturation (SVO2, SCVO2) which are surrogate markers for cardiac output, tissue perfusion were recorded, and blood obtained for troponin level. Results: SVO2 and SCVO2 were significantly higher in Gr L versus Gr M. Postoperative troponin-I concentrations, need of other inotropes incidence of arrhythmia, re-intubation, Intensive care unit(ICU) stay and hospital stay were significantly decreased in Gr L. Conclusion: Prophylactic levosimendan infusion maintains better hemodynamic control, tissue perfusion, myocardial protection and lesser complications in patients with compromised ventricular function.

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“…Des Weiteren erhöht sich der Blutfluss zu den Geweben, wie z. B. der Mukosa des Magens [49,80], dem Nierenmark, dem Dünndarm sowie der Leber [63] und verbessert somit deren Oxygenierung. Die Vasodilatation im pulmonalen Kreislauf senkt den pulmonalvaskulären Widerstandsindex (PV-RI) [55] und die rechtsventrikulären (RV-)Füllungsdrücke [84]; dies führt zusammen mit der positiven Inotropie von Levosimendan zu einer Steigerung der Kontraktilität und mechanischen Effektivität des rechten Ventrikels [35,101].…”

Section: Wirkmechanismen Und Kardiovaskuläre Effekteunclassified

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Rehberg¹,

Ertmer²,

Aken³

et al. 2007

Anaesthesist

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Levosimendan is a calcium sensitizer that is currently in the focus of intensive care medicine because it may be superior to standard inotropic agents in the treatment of acute myocardial insufficiency. The effects of levosimendan mainly depend on three predominant mechanisms: 1) positive inotropic effect by increasing the sensitivity of cardiac myofilaments to calcium ions, 2) vasodilatory effect by stimulation of adenosine triphosphate-sensitive potassium channels and 3) inhibition of phosphodiesterase-III. In a large number of experimental and clinical studies further possible indications for levosimendan have been described, e.g. cardioprotection during ischemia, cardiogenic shock, septic myocardial insufficiency and pulmonary hypertension. This review article critically summarizes the current scientific and clinical knowledge about levosimendan, its pharmacologic characteristics, mechanisms of action as well as indications and potential risks.

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Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs*

Cited by 70 publications

References 53 publications

Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

Outcome of Prophylactic Use of Levosimendan andMilrinone in Open Heart Surgery With CompromisedVentricular Function–A Comparative Study

Role of Levosimendan in intensive care treatment of myocardial insufficiency

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