PubMed · 15060783
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Friedrich C Luft. 2004-04-02. Escalator-driven research.. https://doi.org/10.1007/s00109-004-0536-1
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OBJECTIVE: Calcium desensitization plays an important part in the pathophysiology of septic myocardial depression. We postulated that levosimendan, a new calcium sensitizer, would be beneficial in sepsis-induced cardiac dysfunction. DESIGN AND SETTING: Prospective, randomized, controlled study in two university hospital intensive care units. PATIENTS AND PARTICIPANTS: Twenty-eight patients with persisting left ventricular dysfunction related to septic shock after 48 h of conventional treatment including dobutamine (5 microg/kg per minute). INTERVENTIONS: After 48 h of conventional treatment patients were randomized to receive a 24-h infusion of either levosimendan (0.2 microg/kg per minute, n=15) or dobutamine (5 microg/kg per minute, n=13). MEASUREMENTS AND RESULTS: Data from right heart catheterization, echocardiography, gastric tonometry, laser-Doppler flowmetry, and lactate concentrations and creatinine clearance were obtained before and after the 24-h drug infusion. Dobutamine did not change systemic or regional hemodynamic variables. By contrast, at the same mean arterial pressure levosimendan decreased pulmonary artery occlusion pressure and increased cardiac index. Levosimendan decreased left ventricular end-diastolic volume and increased left ventricular ejection fraction. Levosimendan increased gastric mucosal flow, creatinine clearance, and urinary output while it decreased lactate concentrations. CONCLUSIONS: These findings show that levosimendan improves systemic hemodynamics and regional perfusion in patients with septic cardiac dysfunction under conditions where administration of 5 microg/kg dobutamine per minute is no longer efficacious. Accordingly, our results suggest that levosimendan can be an alternative to the strategy of increasing the dose of dobutamine under such conditions.
BACKGROUND: B-type natriuretic peptide (BNP) is a cardiac hormone that regulates hemodynamic equilibrium and alleviates ventricular stress. In patients with chronic heart failure, BNP levels increase in proportion to the severity of clinical symptoms and degree of decreased left ventricular ejection fraction. BNP has clinical utility in the evaluation, management, and prognosis of patients with heart failure. METHODS: We evaluated the analytical performance characteristics of the BNP immunochemiluminometric assay in the ACS:180 instrument at three hospital laboratory sites. The analytical performance characteristics evaluated included imprecision, sensitivity (minimum detectable concentration, MDC), analytical measurement range (AMR), dilution linearity/recovery, lot-to-lot reagent variation, high-dose hook effect, and comparison against ADVIA Centaur BNP results on patients' EDTA-plasma samples. RESULTS: Total imprecision was <10% coefficient of variation at BNP concentrations of 43-1830 pg/ml; MDC was 6.9 pg/ml; AMR was 6.9-5000 pg/ml; overall recovery of BNP in samples diluted up to 1:10 was 98%; there was no lot-to-lot reagent variation in BNP results and no high-dose hook effect at BNP concentrations up to 100,000 pg/ml; and, ACS:180 results were highly correlated (r=0.996) with Centaur BNP results. CONCLUSIONS: The ACS:180 BNP assay demonstrated excellent analytical performance characteristics and agreement with BNP results obtained using the Centaur instrument.
The Jarvik 2000 system of axial-flow LVAD-is implanted for permanent mechanical circularly support in patients with end-stage heart failure waiting to undergo heart transplantation. The battery is connected with a power plug to the percutaneous skull-mounted footplate, which is monocortically fixated to the retro auricular bone. Patient selection should be highly specific, including careful preoperative evaluation. No device failures have been published so far, but complications can occur due to heparinisation. We describe the procedure from the perspective of the maxillofacial surgeon and give suggestions to prevent surgical complications.