Vasoactive agents for the treatment of sepsis

Abstract

The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myocardium to calcium. Some preliminary studies showed a promising result of levosimendan on reducing mortality.

Herz in der Sepsis

“…Daher liegt es nahe, einen therapeutischen Ansatz in der Herzfrequenzreduktion bei Patienten mit septischer Kardiomyopathie zu sehen [115]. Der Einsatz von Esmolol zur Kontrolle der Herzfrequenz in der Sepsis wurde als offene, randomisierte Phase-2-Studie in einem Zentrum an insgesamt 144 Patienten im septischen Schock überprüft [74].…”

Protective effects of rutin on lipopolysaccharide-induced heart injury in mice

“…Sepsis is one of major pathological features in ICU patients, and can cause failure of multiple organs and even death (Antonucci et al, 2014;Polat et al, 2017;Dellinger, 2013). The heart is one of the sensitive organs in sepsis (Rudiger and Singer, 2013;Zhang and Chen, 2016), which is characterized by ventricular dilation, reduced ventricular ejection fraction, and abnormal cardiac diastolic and contractility (Fernandes and de Assuncao, 2012;Niederbichler et al, 2006;Vieillard-Baron et al, 2008). Furthermore, heart disease is the main cause of a high mortality rate in sepsis (Court et al, 2002;Parrillo, 1989).…”

Effects of levosimendan on mortality in patients with septic shock: systematic review with meta-analysis and trial sequential analysis

“…Nevertheless, the primary outcome of this study was negative, as well as the most secondary endpoints. Besides, the large randomized controlled trial [ 22 ] indicated that levosimendan was associated with a higher risk of supraventricular tachyarrhythmia compared to control and another severe side effect of levosimendan, such as severe vasoplegia that might be difficult to control, should be in attention [ 21 ].…”

“…A recent meta-analysis indicated that levosimendan was associated with significantly reduced risk of death as compared to the conventional inotropes [ 20 ]. A recent review article also illustrated that Levosimendan might be potentially beneficial in reducing mortality risk [ 21 ]. However, one recently large trial demonstrated controversial result.…”