Abstract:
OBJECTIVE:Levosimendan is a novel inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in septic settings. The purpose of the present study was to study the effects of this drug in a porcine model of endotoxemia. DESIGN:Prospective experimental study. SUBJECTS:Fourteen landrace pigs. INTERVENTIONS:All animals were anesthetized and catheterized for measurement of central and pulmonary hemodynamics. Ultrasonic flow probes were placed around the renal artery and portal vein to measure blood flow. A tonometer was placed in the ileum to measure mucosal pH. Levosimendan was given to six animals as a bolus (200 microg x kg(-1)) followed by a continuous infusion (200 microg x kg(-1) x hr(-1)). Thirty minutes after onset of levosimendan treatment, all animals received endotoxin (20 microg x kg(-1) x hr(-1) for 3 hrs). MEASUREMENTS AND MAIN RESULTS:At baseline, levosimendan induced a systemic vasodilation with a reduction in blood pressure and an increase in heart rate. A tendency to an increase in cardiac index did not reach statistical significance (p =.055). Cardiac index and systemic oxygen delivery were markedly improved in the levosimendan group during endotoxemia. Systemic vascular resistance and blood pressure were reduced in the levosimendan group. The latter parameter, however, was only different from the control group during the initial phase of endotoxin shock but not at the late, most pronounced phase of shock. Levosimendan also efficiently attenuated endotoxin-induced pulmonary hypertension. Portal venous blood flow and gut oxygen delivery were improved, but no concomitant reduction in endotoxin-induced intestinal mucosal acidosis was observed. Renal blood flow was unaffected, as was the endotoxin-induced increase in plasma endothelin-1-like immunoreactivity. These findings support previous reports of calcium desensitization as a potential component in septic myocardial depression. Furthermore, the vasodilatory properties of this drug were well tolerated in the current model of hypodynamic endotoxin shock, and they may have contributed to improved regional blood flow as seen in the gut as well as improved systemic perfusion by means of reduced biventricular afterload. CONCLUSION:Pretreatment with levosimendan in pigs subjected to endotoxin shock improved cardiac output and systemic and gut oxygen delivery. In addition, pulmonary hypertension largely was attenuated without any adverse effects on gas exchange. These results are promising in several aspects, but the role of levosimendan in the treating circulatory failure in sepsis remains to be established.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Oldner A,Konrad D,Weitzberg E,Rudehill A,Rossi P,Wanecek Mdoi
10.1097/00003246-200111000-00022subject
Has Abstractpub_date
2001-11-01 00:00:00pages
2185-93issue
11eissn
0090-3493issn
1530-0293journal_volume
29pub_type
杂志文章abstract:OBJECTIVE:Mitochondrial damage and dysfunction are thought to play an important role in the pathogenesis of sepsis-induced organ failures. Unfortunately, specific markers of mitochondrial damage in vital organs do not currently exist. Recently, carbomyl phosphate synthase (CPS)-1, a protein primarily localized to liver...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000230240.02216.21
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVES:Acute hemolysis is associated with organ damage, inflammation, and impaired vascular function. Stimulation of the cholecystokinin-1 receptor-dependent vagal anti-inflammatory reflex with lipid-rich enteral nutrition was demonstrated to prevent tissue damage and attenuate inflammation. This study investigates...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828e9262
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVES:Granulocyte transfusions have been used to treat immune cell dysfunction in sepsis. As granulocyte transfusions can trigger tissue injury via local effects of neutrophils, we hypothesized that extracorporeal treatment of plasma using granulocytes would prove beneficial while having less side effects. DESIGN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318194aa77
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To discuss a potential role for endothelial cell apoptosis in the pathogenesis of sepsis. DATA SOURCES:Studies published in biomedical journals and studies from the authors' laboratory. STUDY SELECTION:In vitro and in vivo studies of endothelial cell apoptosis in endotoxin and sepsis models. DATA EXTRACTIO...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200205001-00009
更新日期:2002-05-01 00:00:00
abstract::Arterial catheterization for blood gas analysis and direct monitoring of blood pressure in infants and children can be attended by a variety of complications, which limit its use to short periods of time. An improved technique, consisting of elimination of stopcocks, the use of a continuous flushing system adapted for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197605000-00010
更新日期:1976-05-01 00:00:00
abstract:OBJECTIVES:To test whether hospital-based physicians made different intensive care unit and life-sustaining treatment decisions for otherwise identical black and white patients with end-stage cancer and life-threatening hypoxia. DESIGN:We conducted a randomized trial of the relationship between patient race and physic...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3182186e98
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective. DATA SOURCES:Systematic literature searc...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000000148
更新日期:2014-05-01 00:00:00
abstract::Several variables may account for the response of electrochemical skin surface PO2 sensors to anesthetic gases: cathode material and size, pH of the electrolyte and membrane material. These variables cannot be chosen arbitrarily and their influence has been tested with two types of sensors. In one type (LSC), a large ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198110000-00010
更新日期:1981-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of spontaneous gasping on cardiorespiratory functions and the ability to resuscitate during experimental cardiac arrest. DATA SOURCES:Studies in rat and pig models during cardiac arrest and cardiopulmonary resuscitation (CPR). STUDY SELECTION:We retrospectively examined the role of sp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00027
更新日期:1994-05-01 00:00:00
abstract:PURPOSE:To review the rationale for adenosine triphosphate-magnesium chloride (ATP-MgCl2) administration in shock, ischemia, and sepsis; the beneficial effects on cellular and organ functions and survival; and possible mechanisms of these effects. DATA SOURCES:Current literature review. STUDY SELECTION:Articles deeme...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199202000-00015
更新日期:1992-02-01 00:00:00
abstract::Nineteen patients with acute anterior myocardial infarction who were hypertensive (systolic BP greater than or equal to 170 mm Hg and/or diastolic BP greater than or equal to 100 mm Hg) at the time of admission were treated with continuous infusion of sodium nitroprusside (NP). The administration of NP resulted in a s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198310000-00010
更新日期:1983-10-01 00:00:00
abstract::Varying concentrations of lipopolysaccharide (LPS) and mannan suspensions were mixed with either saline or plasma from normal volunteers, heated to 100 degrees C for 10 min, and then subjected to the limulus amebocyte lysate test (LAL). A positive LAL in saline required minimum LPS and mannan concentrations of 10(-11)...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198512000-00016
更新日期:1985-12-01 00:00:00
abstract::Cardiogenic shock is the most common cause of death in patients hospitalized with acute myocardial infarction and is associated with a poor prognosis. More than 75% of cases are due to extensive left ventricular infarction and ventricular failure. Other causes include right ventricular infarction and papillary muscle ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000296268.57993.90
更新日期:2008-01-01 00:00:00
abstract::Clinical impressions about the problem of defibrillation during states of acid-base imbalance and hypoxia have been influenced by studies involving the effect of these derangements on the ventricular fibrillation threshold. Based on body weight, energy requirements for defibrillation in normal dogs were compared to re...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197507000-00003
更新日期:1975-07-01 00:00:00
abstract::Sequential assessment of renal function in 50 critically ill postoperative patients was done by simultaneous determinants of osmolar, free water, creatinine and sodium clearances, and fractional excretion of sodium. The traumatic and nontraumatic critically ill surgical patients had a characteristic pattern of creatin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198002000-00004
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVES:Although pentoxifylline produces various beneficial effects following adverse circulatory conditions, it is not known whether this agent has any effects on gut lipid metabolism after trauma-hemorrhage and resuscitation. The aim of this study, therefore, was to determine whether or not administration of pento...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199801000-00023
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND AND METHODS:The development of a multifactorial coagulopathy after massive transfusion is a well-recognized clinical problem that is almost always accompanied by hypothermia. The purpose of this study was to investigate the isolated effect of alterations of temperature on the integrity of the coagulation cas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199210000-00007
更新日期:1992-10-01 00:00:00
abstract:OBJECTIVES:: To determine the relationship between intra-abdominal sepsis-induced high mobility group-box 1 and diaphragm contractile performance and to determine the inhibitory effects of antibodies for high mobility group-box 1 and receptor for advanced glycation end-products on septic peritonitis-induced diaphragmat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a930f7
更新日期:2009-09-01 00:00:00
abstract::Little is known about the structure and objectives of various hospital ethics committees due to their need to preserve confidentiality, their reluctance to reveal internal hospital problems, and their concern about becoming involved in the developing debate about the appropriate role and value of such committees. The ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198211000-00018
更新日期:1982-11-01 00:00:00
abstract:OBJECTIVES:There is controversy regarding the benefits of N-acetylcysteine in acute kidney injury. This study was to compare three commonly used regimens and explore which regimen is best for the protection of acute kidney injury. DESIGN:Prospective experimental study. SETTING:University research laboratory. INTERVE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31822575fc
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To determine the influence of a selective, sterile central nervous system surgery on immune reactivity, particularly whether a decrease of monocytic human leukocyte antigen-DR expression, indicating immunodepression, occurs after neurosurgery and if this measurement is useful for identification of patients wi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199512000-00006
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:We recently reported that bacterial lipopolysaccharide stimulates release of tumor necrosis factor (TNF)-alpha from both human vascular tissue and cultured smooth muscle cells. In the current study, we tested the hypothesis that increased intracellular cyclic adenosine 3',5'-monophosphate (cAMP) could inhibi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199711000-00025
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:To assess whether paralysis alters pulmonary deposition of albuterol delivered by metered dose inhaler and spacer to small animals. DESIGN:A parallel group study of intubated and ventilated rabbits. INTERVENTIONS:Animals in group 1 (n = 7) were paralyzed with intravenous pancuronium, and ventilated at a rat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199701000-00026
更新日期:1997-01-01 00:00:00
abstract:OBJECTIVE:Delirium is common in mechanically ventilated patients in the ICU and associated with short- and long-term morbidity and mortality. The use of systemic corticosteroids is also common in the ICU. Outside the ICU setting, corticosteroids are a recognized risk factor for delirium, but their relationship with del...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/CCM.0000000000000247
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:Expert task forces have proposed that adult critical care medicine services should be regionalized in order to improve outcomes. However, it is currently unknown if high intensive care unit (ICU) patient volumes are associated with reduced mortality rate. The objective was to investigate whether high-volume I...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000226415.93237.84
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:One in five Americans dies following treatment in an intensive care unit (ICU), and evidence indicates the need to improve end-of-life care for ICU patients. We conducted this study to elicit the views and experiences of ICU directors regarding barriers to optimal end-of-life care and to identify the type, av...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000239233.63425.1D
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVES:There has long-been controversy about the possible superiority of norepinephrine compared to dopamine in the treatment of shock. The objective was to evaluate the effects of norepinephrine and dopamine on outcome and adverse events in patients with septic shock. DATA SOURCES:A systematic search of the MEDLI...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e31823778ee
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:Acute renal tubular injury is a serious complication in the postoperative period, which is associated with high mortality and increased ICU stay. We aimed to demonstrate the protective effect of rhEPO against acute tubular injury induced by ischemia-reperfusion and to explore the mechanism of canonical transi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000542
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Hypertonic saline is the recommended therapy to shrink swollen brain cells in patients with acute hyponatremia accompanied by seizures. OBJECTIVES:In the absence of hypertonic saline, hypertonic mannitol will shrink the cell volume. Because mannitol is excreted rapidly, our aim was to ensure that it would b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00037
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:Treatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolism in humans. We stu...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200010000-00001
更新日期:2000-10-01 00:00:00