Abstract
Levosimendan (LS) is a myocardial calcium sensitiser indicated for the treatment of acute decompensated heart failure. This randomised, double-blind trial evaluated the haemodynamic effects of LS in low-risk patients (n = 23) following coronary artery bypass surgery. The effects of LS on myocardial oxygen (O2) consumption, coronary blood flow and systemic haemodynamics were measured by thermodilution. Patients received LS, 8 μg/kg (n = 8), or LS, 24 μg/kg (n = 7), or placebo (n = 8) as a 5-min infusion 1 hour after surgery. Measurements of systemic and coronary sinus haemodynamics, myocardial O2 consumption and cardiac substrate utilisation were made, before and after treatment with LS. Levosimendan, 8 μg/kg and 24 μg/kg, significantly increased cardiac output (CO) by 0.7 and 1.6 l/min, respectively (P < 0.05), compared to baseline. Mean arterial pressure and pulmonary vascular resistance decreased significantly with both doses of LS, as did coronary artery resistance, the latter being indicative of coronary vasodilation (P < 0.05). Furthermore, an increase in coronary blood flow of 28 ml/min and 42 ml/min with LS, 8 μg/kg and 24 μg/kg, respectively, was obtained (P = 0.054 for both doses combined). Despite the markedly improved cardiac function seen with LS, neither dose significantly increased myocardial O2 consumption compared with placebo. In addition, no significant differences in myocardial free fatty acid, lactate, pyruvate and glucose utilisation were observed in LS-treated patients compared to placebo controls. In conclusion, based on the results of this study, LS may be of significant benefit in improving cardiac function in patients with low CO following coronary artery bypass surgery, with no significant increase in O2 consumption.
Highlights
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]
Several small studies have suggested that closed suction catheters offer benefits over open suction because disconnection from the ventilator circuit is not required [1], thereby maintaining ventilation, FIO2 and PEEP
Due to the prolonged stay of the critically ill under mechanical ventilation in intensive care unit (ICU) often stomatotracheal intubation should be replaced by tracheostomy
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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