Introduction
Cardiovascular dysfunction (CD) occurs frequently among patients with septic shock and it is more severe in the first 3 days, relapsing at the end of the first week among those who survive. Fifteen percent of the patients with septic shock, who evolve to death, die as a result of CD, whose physiopathologic mechanisms are not fully understood. Levosimedan (LEVO), a new inotropic drug which acts as calcium sensitizing agent and also has effects on potassium channels in vascular smooth muscle cells leading to vasodilatation action, has shown benefits in patients with cardiac failure. An experimental study on the endotoxic shock model has shown improvement on cardiac output, and systemic and regional oxygenation. The aim of this study is to prove the acute hemodynamic effects of LEVO administration on septic patients with severe CD.
Materials and methods
SLS, 70 years old, male, with a history of ischemic cardiomyopathy was admitted with pulmonary infection sepsis and multiple organ dysfunction. The patient received LEVO without bolus dose at an initial rate of 0.1 μg/kg/min in the first hour, followed by 0.2 μg/kg/min during the next 24 hours, monitored with a pulmonary arterial catheter during the observation.
Results
The main hemodynamic and metabolic data are shown in Table 1.
Table 1.
| Baseline* | 18 h of treatment# | After 1 h EVO** | After 3 h EVO## | 12 h with EVO | 24 h with LEVO## | Without LEVO 2 h | Without LEVO 12 h | Without LEVO 24 h | Without LEVO 48 h | |
|---|---|---|---|---|---|---|---|---|---|---|
| CI | 1.4 | 2.8 | 2.8 | 3.3 | 3.2 | 4.2 | 3.6 | 3.6 | 3.7 | 4.4 |
| MAP | 73 | 92 | 78 | 70 | 70 | 66 | 73 | 88 | 79 | 93 |
| PAOP | 22 | 21 | 16 | 21 | 14 | 20 | 20 | 22 | 21 | 22 |
| SVO2 | 68 | 75 | 78 | 79 | 75 | 74 | 74 | 75 | 73 | 77 |
| VO2 | 85 | 90 | 94 | 102 | 111 | 123 | 122 | 119 | 143 | 121 |
| Lactate | 7.43 | 5.21 | 2.55 | 1.77 | 1.55 | 1.77 | 1.55 | 1.55 | 1.54 | 1.91 |
Hemodynamic support: * 0.6 μg/kg/min noradrenalin + 20 μg/kg/min dobutamine. # 30 μg/kg/min dobutamine + 5 l Ringer's solution + 500 ml hydroxyethylstarch (HES) (200/0.5). ** 20 μg/kg/min dobutamine + 0.1 μg/kg/min levosimedan (LEVO). ## 0.2 μg/kg/min LEVO + 500 ml HES (200/0.5).
Conclusion
The administration of LEVO in patients with sepsis and septic shock and severe CD has proved to be safe, with immediate improvement of hemodynamic and metabolic parameters that was maintained after discontinuation of the drug. It is necessary that a randomized, controlled trial be done to compare the use of LEVO and other inotropic drugs in the treatment of CD associated with sepsis in order to validate this new indication for the drug.