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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, November 6, 2016

Levosimendan in Septic Shock

PulmCCM - November 5, 2016 - By JE
..."Deep within the sulci of every intensivist’s cortex lies the accepted importance of inotropic support in the face of presumed septic cardiomyopathy. This almost certainly arises from the notion of central venous oxygen saturation as a part of the venerable early goal directed therapy algorithm for severe sepsis and septic shock. This, of course, was borrowed by Dr. Rivers from the goal directed therapy of the 1980s, using oxygen kinetics as a surrogate for cardiac output.
While dobutamine was classically used, excitement has swirled about the use of a novel inotrope, levosimendan. With this in mind, the authors of the LeoPARD trial sought to feed the sparrow in the heart of those suffering from septic shock and - hopefully - reduce organ dysfunction as measured by the SOFA score.
The Results
The primary outcome was change in daily SOFA score and there was no statistically significant difference between placebo and levosimendan. However, there was a trend to lower SOFA score in placebo which may have been largely driven by a lower cardiovascular SOFA score in the placebo group; the difference was lessened when the cardiovascular system was excluded from the SOFA score. There was a non-statistically significant trend for increased 28 day mortality in those who received levosimendan as compared to placebo [34.5% versus 30.9% mortality at 28 days]. 8 patients in the levosimendan group suffered a supraventricular tachycardia as compared to 1 patient in placebo. Patients randomized to receive levosimendan were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days [HR of 0.77]..."