Journal ArticleDOI
Effects of levosimendan on right ventricular afterload in patients with acute respiratory distress syndrome: a pilot study.
Andrea Morelli,Jean-Louis Teboul,Salvatore Maurizio Maggiore,Antoine Vieillard-Baron,Monica Rocco,Giorgio Conti,Andrea De Gaetano,Umberto Picchini,Alessandra Orecchioni,Iacopo Carbone,Luigi Tritapepe,Paolo Pietropaoli,Martin Westphal +12 more
Reads0
Chats0
TLDR
Evidence is provided that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS and is able to improve the overall prognosis of patients with sepsis and ARDS.Abstract:
OBJECTIVE: Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS. DESIGN: Prospective, randomized, placebo-controlled, pilot study. SETTING: Twenty-two-bed multidisciplinary intensive care unit of a university hospital. PATIENTS: Thirty-five patients with ARDS in association with septic shock. INTERVENTIONS: Patients were randomly allocated to receive a 24-hr infusion of either levosimendan 0.2 microg/kg/min (n = 18) or placebo (n = 17). Data from right heart catheterization, cardiac magnetic resonance, arterial and mixed venous oxygen tensions and saturations, and carbon dioxide tensions were obtained before and 24 hrs after drug infusion. MEASUREMENTS AND MAIN RESULTS: At a mean arterial pressure between 70 and 80 mm Hg (sustained with norepinephrine infusion), levosimendan increased cardiac index (from 3.8 +/- 1.1 to 4.2 +/- 1.0 L/min/m) and decreased mean pulmonary artery pressure (from 29 +/- 3 to 25 +/- 3 mm Hg) and pulmonary vascular resistance index (from 290 +/- 77 to 213 +/- 50 dynes/s/cm(5)/m(2); each p < .05). Levosimendan also decreased right ventricular end-systolic volume and increased right ventricular ejection fraction (p < .05). In addition, levosimendan increased mixed venous oxygen saturation (from 63 +/- 8 to 70 +/- 8%; p < .01). CONCLUSIONS: This study provides evidence that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS. A large multiple-center trial is needed to investigate whether levosimendan is able to improve the overall prognosis of patients with sepsis and ARDS. (Less)read more
Citations
More filters
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: A consensus committee of 55 international experts representing 25 international organizations was assembled at key international meetings (forSurviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012 as discussed by the authors ).
Journal ArticleDOI
Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine*
Joe Brierley,Joseph A. Carcillo,Karen Choong,Timothy T. Cornell,Allan deCaen,Andreas J. Deymann,Allan Doctor,Alan L. Davis,John Duff,Marc Andre Dugas,Alan W. Duncan,Barry Evans,Jonathan D. Feldman,Kathryn Felmet,Gene Fisher,Lorry R. Frankel,Howard E. Jeffries,Bruce M. Greenwald,Juan Gutierrez,Mark W. Hall,Yong Y. Han,James Hanson,Jan A. Hazelzet,Lynn J. Hernan,Jane Kiff,Niranjan Kissoon,Alexander A. Kon,Jose Irazusta,John C. Lin,Angie Lorts,Michelle Mariscalco,Renuka Mehta,Simon Nadel,Trung Nguyen,Carol Nicholson,Mark J. Peters,Regina Okhuysen-Cawley,Tom Poulton,Monica Relves,Agustin Rodriguez,Ranna A. Rozenfeld,Eduardo Schnitzler,Tom Shanley,Sara Skache,Peter Skippen,Adalberto Torres,Bettina Von Dessauer,Jacki Weingarten,Timothy S. Yeh,Arno Zaritsky,Bonnie J. Stojadinovic,Jerry J. Zimmerman,Aaron L. Zuckerberg +52 more
TL;DR: The 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock continues to emphasize early use of age-specific therapies to attain time-sensitive goals, and a major new recommendation in the 2007 update is earlier use of inotrope support through peripheral access until central access is attained.
Journal ArticleDOI
American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.
Alan L. Davis,Joseph A. Carcillo,Rajesh K. Aneja,Andreas J. Deymann,John C. Lin,Trung C. Nguyen,Regina Okhuysen-Cawley,Monica S. Relvas,Ranna A. Rozenfeld,Peter Skippen,Bonnie J. Stojadinovic,Eric A. Williams,Tim S. Yeh,Fran Balamuth,Joe Brierley,Allan R. de Caen,Ira M. Cheifetz,Karen Choong,Edward E. Conway,Timothy T. Cornell,Allan Doctor,Marc Andre Dugas,Jonathan D. Feldman,Julie C. Fitzgerald,Heidi R. Flori,James D. Fortenberry,Ana Lia Graciano,Bruce M. Greenwald,Mark W. Hall,Yong Yun Han,Lynn J. Hernan,Jose Irazuzta,Elizabeth Iselin,Elise W. van der Jagt,Howard E. Jeffries,Saraswati Kache,Chhavi Katyal,Niranjan Kissoon,Alexander A. Kon,Martha C. Kutko,Graeme MacLaren,Graeme MacLaren,Timothy M. Maul,Renuka Mehta,Fola Odetola,Kristine A Parbuoni,Raina Paul,Mark J. Peters,Suchitra Ranjit,Karin Reuter-Rice,Eduardo Schnitzler,Halden F. Scott,Adalberto Torres,Jacki Weingarten-Abrams,Scott L. Weiss,Jerry J. Zimmerman,Aaron L. Zuckerberg +56 more
TL;DR: A major new recommendation in the 2014 update of the 2007 American College of Critical Care Medicine “Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock” is consideration of institution—specific use of a recognition bundle containing a trigger tool for rapid identification of patients with septic shock.
Journal ArticleDOI
Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association.
Marvin A. Konstam,Michael S. Kiernan,Daniel Bernstein,Biykem Bozkurt,Miriam Jacob,Navin K. Kapur,Robb D. Kociol,Eldrin F. Lewis,Mandeep R. Mehra,Francis D. Pagani,Amish N. Raval,Carey Ward +11 more
TL;DR: RHF is a complex syndrome including diverse causes, pathways, and pathological processes and multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making.
References
More filters
Journal ArticleDOI
Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis
Roger C. Bone,Robert A. Balk,F. B. Cerra,R. P. Dellinger,A. M. Fein,William A. Knaus,Roland M. H. Schein,W. J. Sibbald +7 more
TL;DR: An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae as mentioned in this paper.
Journal ArticleDOI
Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel P. Rivers,Bryant Nguyen,Suzanne Havstad,Julie Ressler,Alexandria Muzzin,Bernhard P. Knoblich,Edward L. Peterson,Michael C. Tomlanovich +7 more
TL;DR: This study randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit.
Journal ArticleDOI
The American-European Consensus Conference on ARDS: Definitions, mechanisms, relevant outcomes, and clinical trial coordination
Gordon R. Bernard,Antonio Artigas,Kenneth L. Brigham,J. Carlet,K. Falke,L. Hudson,M. Lamy,J. R. LeGall,Alan H. Morris,Roger G. Spragg +9 more
TL;DR: The acute respiratory distress syndrome (ARDS), a process of nonhydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies, carries a high morbidity, mortality, and financial cost.
Journal ArticleDOI
The acute respiratory distress syndrome
TL;DR: An overview of the definitions, clinical features, and epidemiology of the acute respiratory distress syndrome is provided and advances in the areas of pathogenesis, resolution, and treatment are discussed.
Journal ArticleDOI
Inhaled Nitric Oxide for the Adult Respiratory Distress Syndrome
TL;DR: Inhalation of nitric oxide by patients with severe adult respiratory distress syndrome reduces the pulmonary-artery pressure and increases arterial oxygenation by improving the matching of ventilation with perfusion, without producing systemic vasodilation.