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Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial

BACKGROUND: We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock. MATERIAL/METHODS: After achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output...

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Autores principales: Meng, Jian-biao, Hu, Ma-hong, Lai, Zhi-zhen, Ji, Chun-lian, Xu, Xiu-juan, Zhang, Geng, Tian, Shuyuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861009/
https://www.ncbi.nlm.nih.gov/pubmed/27138236
http://dx.doi.org/10.12659/MSM.898457
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author Meng, Jian-biao
Hu, Ma-hong
Lai, Zhi-zhen
Ji, Chun-lian
Xu, Xiu-juan
Zhang, Geng
Tian, Shuyuan
author_facet Meng, Jian-biao
Hu, Ma-hong
Lai, Zhi-zhen
Ji, Chun-lian
Xu, Xiu-juan
Zhang, Geng
Tian, Shuyuan
author_sort Meng, Jian-biao
collection PubMed
description BACKGROUND: We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock. MATERIAL/METHODS: After achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output (left ventricular ejective fraction), LEVF ≤45%) were randomly divided into two groups: levosimendan dobutamine. Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan (0.2 μg/kg/minute) and dobutamine (5 μg/kg/minute) for 24 hours respectively. During treatment we monitored hemodynamics and LVEF, and measured levels of heart-type fatty acid binding protein (HFABP), troponin I (TNI), and brain natriuretic peptide(BNP). In addition, the length of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and 28-day mortality were compared between the two groups. RESULTS: The levosimendan group and the dobutamine group were well matched with respect to age (years, 55.4±1 7.5 versus 50.2±13.6) and gender (males, 68.4% versus 57.9%). Levosimendan-treated patients had higher stroke volume index (SVI), cardiac index (CI), LVEF, and left ventricular stroke work index (LVSWI), and lower extravascular lung water index (EVLWI) compared to dobutamine-treated patients (p<0.05). HFABP, TNI, and BNP in the levosimendan group were less than in the dobutamine group (p<0.05). There was no difference in the mechanical ventilation time, length of stay in ICU and hospital, and 28-day mortality between the two groups. CONCLUSIONS: Compared with dobutamine, levosimendan reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock. However, it does not reduce the days on mechanical ventilation, length of stay in ICU and hospital, or 28-day mortality.
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spelling pubmed-48610092016-05-20 Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial Meng, Jian-biao Hu, Ma-hong Lai, Zhi-zhen Ji, Chun-lian Xu, Xiu-juan Zhang, Geng Tian, Shuyuan Med Sci Monit Clinical Research BACKGROUND: We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock. MATERIAL/METHODS: After achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output (left ventricular ejective fraction), LEVF ≤45%) were randomly divided into two groups: levosimendan dobutamine. Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan (0.2 μg/kg/minute) and dobutamine (5 μg/kg/minute) for 24 hours respectively. During treatment we monitored hemodynamics and LVEF, and measured levels of heart-type fatty acid binding protein (HFABP), troponin I (TNI), and brain natriuretic peptide(BNP). In addition, the length of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and 28-day mortality were compared between the two groups. RESULTS: The levosimendan group and the dobutamine group were well matched with respect to age (years, 55.4±1 7.5 versus 50.2±13.6) and gender (males, 68.4% versus 57.9%). Levosimendan-treated patients had higher stroke volume index (SVI), cardiac index (CI), LVEF, and left ventricular stroke work index (LVSWI), and lower extravascular lung water index (EVLWI) compared to dobutamine-treated patients (p<0.05). HFABP, TNI, and BNP in the levosimendan group were less than in the dobutamine group (p<0.05). There was no difference in the mechanical ventilation time, length of stay in ICU and hospital, and 28-day mortality between the two groups. CONCLUSIONS: Compared with dobutamine, levosimendan reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock. However, it does not reduce the days on mechanical ventilation, length of stay in ICU and hospital, or 28-day mortality. International Scientific Literature, Inc. 2016-05-03 /pmc/articles/PMC4861009/ /pubmed/27138236 http://dx.doi.org/10.12659/MSM.898457 Text en © Med Sci Monit, 2016 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
spellingShingle Clinical Research
Meng, Jian-biao
Hu, Ma-hong
Lai, Zhi-zhen
Ji, Chun-lian
Xu, Xiu-juan
Zhang, Geng
Tian, Shuyuan
Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial
title Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial
title_full Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial
title_fullStr Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial
title_full_unstemmed Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial
title_short Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial
title_sort levosimendan versus dobutamine in myocardial injury patients with septic shock: a randomized controlled trial
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861009/
https://www.ncbi.nlm.nih.gov/pubmed/27138236
http://dx.doi.org/10.12659/MSM.898457
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