Abstract
The novel calcium sensitiser, levosimendan (LS), and the β-adrenoceptor agonist dobutamine (DO), both improve cardiac haemodynamics in patients withsevere low-output heart failure (HF). However, co-administration of β-blockers may influence the action of these inotropic agents. In a multicentre, randomised, double-blind trial in patients with severe low output HF (n = 203), the haemodynamic effects of LS and DO infusions over 24 hours were compared. The influence of concomitant β-blocker therapy (37% in the LS and 39% in the DO groups) were analysed separately. Patients were given either LS (loading dose of 24 μg/kg over 10 min followed by a continuous infusion of 0.1 μg/kg/min), or DO (continuous infusion of 5 μg/kg/min). The infusion rates were doubled if the cardiac index did not increase by ≥ 30% after 2 hours of treatment. The use of β-blockers had significant effects on the increase in cardiac output and the decrease in pulmonary wedge pressure (P = 0.01 and P = 0.03, respectively) (Fig. (Fig.1).1). β-blockade attenuated the effect of DO but did not reduce the effects of LS. There was even a slight trend for improved haemodynamic benefits of LS in patients under β-blockade. These findings suggest that LS may be successfully combined with β-blockers to treat patients with low-output heart failure. Figure 1 Mean changes in cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) in patients given LS (β- n = 69 and β+ n = 33) and DO (β- n = 67 and β+ n = 28).
Highlights
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]
Smaller aerosol particles resulted in greater drug delivery in vitro when using the modified Aeroneb Pro during controlled mechanical ventilation (CMV)
We retrospectively reviewed 107 procedures performed on 48 patients in the period between March 2000 and November 2001
Summary
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]. The aim of this study was to assess the respiratory effects of sufentanil and remifentanil in postsurgical critically ill patients during spontaneous ventilation since the drugs show pharmacokinetic and pharmacodynamic properties which make them attractive for intensive care use. Preliminary evidence suggests that hU-II levels during cardiac surgery are increased in patients with myocardial dysfunction [2] It is not known, if hU-II plasma concentrations are related to pulmonary capillary wedge pressure (PCWP) as an estimate of left ventricular filling pressure. AAF in cardiac surgery postoperative period has been implicated as a complication that leads to longer ICU and hospital stay and to augmented costs It has not been associated with increased mortality rates. We aimed to investigate the effects of use of preoperative and early postoperative standard and immunonutrient products on immune system and acute inflammatory response in the patients undergoing gastrointestinal malignancy surgery.
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