Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock: A Randomized Controlled Pilot Study
INTRODUCTION:Mitochondrial dysfunction and consequent cellular energetic failure play a key role in the development of sepsis-related organs failure. Evidence suggests that the pleiotropic effects of levosimendan may positively affect cellular metabolism during septic shock. OBJECTIVES:To investigat...
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| Veröffentlicht in: | Shock (Augusta, Ga.) Ga.), 2017-09, Vol.48 (3), p.307-312 |
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| creator | Hajjej, Zied Meddeb, Bilel Sellami, Walid Labbene, Iheb Morelli, Andrea Ferjani, Mustapha |
| description | INTRODUCTION:Mitochondrial dysfunction and consequent cellular energetic failure play a key role in the development of sepsis-related organs failure. Evidence suggests that the pleiotropic effects of levosimendan may positively affect cellular metabolism during septic shock.
OBJECTIVES:To investigate changes in the concentration of glucose, lactate, pyruvate, and glycerol in the extracellular fluid of the skeletal muscle following levosimendan administration in patients with septic shock.
METHODS:The study was designed as a prospective, double-blind, controlled, clinical pilot trial and performed in a multidisciplinary intensive care unit. After achieving normovolemia and a mean arterial pressure of at least 65 mm Hg, 20 septic shock patients were randomized to receive either levosimendan 0.2 μg/kg/min (n = 10), or dobutamine 5 μg/kg/min as active comparator (n = 10). Interstitial tissue concentrations of lactate, pyruvate, glucose, and glycerol were obtained by using muscle microdialysis. All measurements, including data from right heart catheterization, were obtained at baseline and every 6 h for the following 72 h after randomization.The trial is registered with Clinicaltrials.gov, number NCT02963454.
RESULTS:Compared with dobutamine, levosimendan increased interstitial tissue pyruvate concentration (153.3 ± 73 and 187. 2 ± 13.5 vs. 210.7 ± 76.2 and 161 ± 64.6; P |
| doi_str_mv | 10.1097/SHK.0000000000000851 |
| format | Article |
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OBJECTIVES:To investigate changes in the concentration of glucose, lactate, pyruvate, and glycerol in the extracellular fluid of the skeletal muscle following levosimendan administration in patients with septic shock.
METHODS:The study was designed as a prospective, double-blind, controlled, clinical pilot trial and performed in a multidisciplinary intensive care unit. After achieving normovolemia and a mean arterial pressure of at least 65 mm Hg, 20 septic shock patients were randomized to receive either levosimendan 0.2 μg/kg/min (n = 10), or dobutamine 5 μg/kg/min as active comparator (n = 10). Interstitial tissue concentrations of lactate, pyruvate, glucose, and glycerol were obtained by using muscle microdialysis. All measurements, including data from right heart catheterization, were obtained at baseline and every 6 h for the following 72 h after randomization.The trial is registered with Clinicaltrials.gov, number NCT02963454.
RESULTS:Compared with dobutamine, levosimendan increased interstitial tissue pyruvate concentration (153.3 ± 73 and 187. 2 ± 13.5 vs. 210.7 ± 76.2 and 161 ± 64.6; P < 0.05), and lactate clearance (55 vs. 10). Lactate/pyruvate ratio was lower in the levosimendan group at the end of study period (37. 7 ± 18.9 and 29.3 ± 12.7 vs. 10.9 ± 4.5 and 31.4 ± 13. 2; P < 0.05).
CONCLUSION:Although we investigated a small number of patients, our preliminary results suggest that levosimendan may improve cellular metabolic alterations in patients with septic shock.</description><identifier>ISSN: 1073-2322</identifier><identifier>EISSN: 1540-0514</identifier><identifier>DOI: 10.1097/SHK.0000000000000851</identifier><identifier>PMID: 28234790</identifier><language>eng</language><publisher>United States: by the Shock Society</publisher><subject>Clinical Science Aspects</subject><ispartof>Shock (Augusta, Ga.), 2017-09, Vol.48 (3), p.307-312</ispartof><rights>2017 by the Shock Society</rights><rights>Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Shock Society. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3601-807ccf2c57c812da7c35b9203ae8900457a89b058318a5196e8e29ab11ba8f703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28234790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hajjej, Zied</creatorcontrib><creatorcontrib>Meddeb, Bilel</creatorcontrib><creatorcontrib>Sellami, Walid</creatorcontrib><creatorcontrib>Labbene, Iheb</creatorcontrib><creatorcontrib>Morelli, Andrea</creatorcontrib><creatorcontrib>Ferjani, Mustapha</creatorcontrib><title>Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock: A Randomized Controlled Pilot Study</title><title>Shock (Augusta, Ga.)</title><addtitle>Shock</addtitle><description>INTRODUCTION:Mitochondrial dysfunction and consequent cellular energetic failure play a key role in the development of sepsis-related organs failure. Evidence suggests that the pleiotropic effects of levosimendan may positively affect cellular metabolism during septic shock.
OBJECTIVES:To investigate changes in the concentration of glucose, lactate, pyruvate, and glycerol in the extracellular fluid of the skeletal muscle following levosimendan administration in patients with septic shock.
METHODS:The study was designed as a prospective, double-blind, controlled, clinical pilot trial and performed in a multidisciplinary intensive care unit. After achieving normovolemia and a mean arterial pressure of at least 65 mm Hg, 20 septic shock patients were randomized to receive either levosimendan 0.2 μg/kg/min (n = 10), or dobutamine 5 μg/kg/min as active comparator (n = 10). Interstitial tissue concentrations of lactate, pyruvate, glucose, and glycerol were obtained by using muscle microdialysis. All measurements, including data from right heart catheterization, were obtained at baseline and every 6 h for the following 72 h after randomization.The trial is registered with Clinicaltrials.gov, number NCT02963454.
RESULTS:Compared with dobutamine, levosimendan increased interstitial tissue pyruvate concentration (153.3 ± 73 and 187. 2 ± 13.5 vs. 210.7 ± 76.2 and 161 ± 64.6; P < 0.05), and lactate clearance (55 vs. 10). Lactate/pyruvate ratio was lower in the levosimendan group at the end of study period (37. 7 ± 18.9 and 29.3 ± 12.7 vs. 10.9 ± 4.5 and 31.4 ± 13. 2; P < 0.05).
CONCLUSION:Although we investigated a small number of patients, our preliminary results suggest that levosimendan may improve cellular metabolic alterations in patients with septic shock.</description><subject>Clinical Science Aspects</subject><issn>1073-2322</issn><issn>1540-0514</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAUhSMEoqXwBgh5ySbFP3HssEAajQpFDKJiQCwtx7khpo49tZ1WRTw8rqZUhQXe-Ej-zrlXPlX1nOBjgjvxanv64RjfP5KTB9Uh4Q2uMSfNw6KxYDVllB5UT1L6gTFtWCceVwdUUtaIDh9Wv07GEUxOKIxoA5ch2Rn8oD0KHq3BucXpiD5C1n1w1qCVyxB1tsEnZD06KxJ8cX-zeUJb2OXCbKdgzl-jFfqs_RBm-xMGtA4-x-BckWfWhYy2eRmun1aPRu0SPLu9j6qvb0--rE_rzad379erTW1Yi0ktsTBmpIYLIwkdtDCM9x3FTIPsMG640LLrMZeMSM1J14IE2umekF7LUWB2VL3Z5-6WfobBlJWjdmoX7azjtQraqr9fvJ3U93CpOCdt28oS8PI2IIaLBVJWs02mfI_2EJakiBSUi6ZteUGbPWpiSCnCeDeGYHVTnCrFqX-LK7YX91e8M_1pqgByD1yFmw7SuVuuIKoJtMvT_7N_A3_0plI</recordid><startdate>201709</startdate><enddate>201709</enddate><creator>Hajjej, Zied</creator><creator>Meddeb, Bilel</creator><creator>Sellami, Walid</creator><creator>Labbene, Iheb</creator><creator>Morelli, Andrea</creator><creator>Ferjani, Mustapha</creator><general>by the Shock Society</general><general>Lippincott Williams & Wilkins</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201709</creationdate><title>Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock: A Randomized Controlled Pilot Study</title><author>Hajjej, Zied ; Meddeb, Bilel ; Sellami, Walid ; Labbene, Iheb ; Morelli, Andrea ; Ferjani, Mustapha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3601-807ccf2c57c812da7c35b9203ae8900457a89b058318a5196e8e29ab11ba8f703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Clinical Science Aspects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hajjej, Zied</creatorcontrib><creatorcontrib>Meddeb, Bilel</creatorcontrib><creatorcontrib>Sellami, Walid</creatorcontrib><creatorcontrib>Labbene, Iheb</creatorcontrib><creatorcontrib>Morelli, Andrea</creatorcontrib><creatorcontrib>Ferjani, Mustapha</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Shock (Augusta, Ga.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hajjej, Zied</au><au>Meddeb, Bilel</au><au>Sellami, Walid</au><au>Labbene, Iheb</au><au>Morelli, Andrea</au><au>Ferjani, Mustapha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock: A Randomized Controlled Pilot Study</atitle><jtitle>Shock (Augusta, Ga.)</jtitle><addtitle>Shock</addtitle><date>2017-09</date><risdate>2017</risdate><volume>48</volume><issue>3</issue><spage>307</spage><epage>312</epage><pages>307-312</pages><issn>1073-2322</issn><eissn>1540-0514</eissn><abstract>INTRODUCTION:Mitochondrial dysfunction and consequent cellular energetic failure play a key role in the development of sepsis-related organs failure. Evidence suggests that the pleiotropic effects of levosimendan may positively affect cellular metabolism during septic shock.
OBJECTIVES:To investigate changes in the concentration of glucose, lactate, pyruvate, and glycerol in the extracellular fluid of the skeletal muscle following levosimendan administration in patients with septic shock.
METHODS:The study was designed as a prospective, double-blind, controlled, clinical pilot trial and performed in a multidisciplinary intensive care unit. After achieving normovolemia and a mean arterial pressure of at least 65 mm Hg, 20 septic shock patients were randomized to receive either levosimendan 0.2 μg/kg/min (n = 10), or dobutamine 5 μg/kg/min as active comparator (n = 10). Interstitial tissue concentrations of lactate, pyruvate, glucose, and glycerol were obtained by using muscle microdialysis. All measurements, including data from right heart catheterization, were obtained at baseline and every 6 h for the following 72 h after randomization.The trial is registered with Clinicaltrials.gov, number NCT02963454.
RESULTS:Compared with dobutamine, levosimendan increased interstitial tissue pyruvate concentration (153.3 ± 73 and 187. 2 ± 13.5 vs. 210.7 ± 76.2 and 161 ± 64.6; P < 0.05), and lactate clearance (55 vs. 10). Lactate/pyruvate ratio was lower in the levosimendan group at the end of study period (37. 7 ± 18.9 and 29.3 ± 12.7 vs. 10.9 ± 4.5 and 31.4 ± 13. 2; P < 0.05).
CONCLUSION:Although we investigated a small number of patients, our preliminary results suggest that levosimendan may improve cellular metabolic alterations in patients with septic shock.</abstract><cop>United States</cop><pub>by the Shock Society</pub><pmid>28234790</pmid><doi>10.1097/SHK.0000000000000851</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Clinical Science Aspects |
| title | Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock: A Randomized Controlled Pilot Study |
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