Efectos hemodinámicos del levosimendan en el postoperatorio de pacientes sometidos a cirugía cardiaca / Hemodynamic effects of levosimendan following cardiac surgery

RESUMEN

Se compararon 30 pacientes adultos sometidos a cirugía cardiaca programada con circulación extracorpórea al objeto de estudiar el efecto de la dobutamina y levosimendan sobre la hemodinámica. Quince pacientes recibieron levosimendan en dosis bolus de 12 μg kg-1 en 15-20 min seguidos de una infusión de 0,2 μg kg-1 min-1 durante 24 horas (grupo levosimendan). Otros 15 enfermos recibieron una infusión de dobutamina en dosis de 7,5 μg kg-1 min-1. Los parámetros hemodinámicos fueron medidos antes de comenzar la infusión del fármaco y a las 24 horas de tratamiento. La evolución de los principales parámetros hemodinámicos es la siguiente Grupo dobutamina Frecuencia cardiaca (latidos /min) 87,15 ± 10,22 (basal) 87,91 ± 6,00 (24 horas); Presión arterial media (mmHg) 83,96 ± 10,57 (basal) 86,41 ± 13,29 (24 horas); Índice cardiaco (l/min/m2) 2,21 ± 0,23 (basal) 2,53 ± 0,35 (24 horas); resistencias vasculares periféricas (dyn seg-1cm-5) 1436,74 ± 311,48 (basal) 1378,35 ± 320,68 (24 horas). Grupo levosimendan Frecuencia cardiaca (latidos/ min) 84,28 ± 12,18 (basal) 96,02 ± 9,10 (24 horas); Presión arterial media (mm Hg) 83,59 ± 9,05 (basal) 74,29 ± 6,33 (24 horas); Índice cardiaco (l/min/m2) 2,16 ± 0,28 (basal) 3,02 ± 0,34 (24 horas); resistencias vasculares periféricas (dyn seg-1cm-5) 1578,93 ± 334,88 (basal) 1136,68 ± 158,60 (24 horas). Encontramos que las resistencias vasculares y la presión arterial media disminuyen de forma significativa (p<0,05) en el grupo levosimendan, pero no en el grupo dobutamina y que la frecuencia cardiaca y el índice cardiaco aumentan en el grupo levosimendan pero no en el grupo dobutamina. Concluimos que el levosimendan mejora la situación hemodinámica de estos pacientes y es una alternativa en el tratamiento del síndrome de bajo gasto postoperatorio

ABSTRACT

The hemodynamic effect of levosimendan was compared to that of dobutamine in a trial enrolling 30 adults undergoing scheduled cardiac surgery with cardiopulmonary bypass. Fifteen patients were randomly assigned to receive levosimendan in a single dose of 18 µg.kg-1 followed in 15 to 20 minutes by start of infusion at a rate of 0.2 µg.kg-1min-1 for 24 hours (levosimendan group). Another 15 randomized patients received dobutamine infused at a rate of 7.5 µg.kg-1min-1. Hemodynamic parameters were measured before starting infusion of the drug and after 24 hours of treatment. Changes in the main hemodynamic parameters were as follows. In the levosimendan group heart rate (beats/min) was 87.15 (SD 10.22) at baseline and 87.91 (6.00) at 24 hours; mean arterial pressure (mm Hg) was 83.96 (10.57) at baseline and 86.41 (13.29) after 24 hours; cardiac index (L/min/m2) was 2.21 (0.23) at baseline and 2.53 (0.35) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1436.74 (311.48) at baseline and 1378.35 (320.68) at 24 hours. In the dobutamine group heart rate (beats/min) was 84.28 (2.18) at baseline and 96.02 (9.10) after 24 hours; mean arterial pressure (mm Hg) was 83.59 (9.05) at baseline and 74.29 (6.33) at 24 hours; cardiac index (L/min/m2) was 2.16 (0.28) at baseline and) 3.02 (0.34) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1578.93 (334.88) at baseline and 1136.68 (158.60) at 24 hours. We found that mean arterial pressure and both systemic and pulmonary vascular resistance decreased significantly in the levosimendan group (P<0.05), but not in the dobutamine group. On the other hand, both heart rate and cardiac index increased in the levosimendan group only (P<0.05). We conclude that levosimendan improves hemodynamic stability in patients who have undergone cardiac surgery and that it is a good alternative for treating postoperative low cardiac output syndromeThe hemodynamic effect of levosimendan was compared to that of dobutamine in a trial enrolling 30 adults undergoing scheduled cardiac surgery with cardiopulmonary bypass. Fifteen patients were randomly assigned to receive levosimendan in a single dose of 18 μg.kg-1 followed in 15 to 20 minutes by start of infusion at a rate of 0.2 μg.kg-1min-1 for 24 hours (levosimendan group). Another 15 randomized patients received dobutamine infused at a rate of 7.5 μg.kg-1min-1. Hemodynamic parameters were measured before starting infusion of the drug and after 24 hours of treatment. Changes in the main hemodynamic parameters were as follows. In the levosimendan group heart rate (beats/min) was 87.15 (SD 10.22) at baseline and 87.91 (6.00) at 24 hours; mean arterial pressure (mm Hg) was 83.96 (10.57) at baseline and 86.41 (13.29) after 24 hours; cardiac index (L/min/m2) was 2.21 (0.23) at baseline and 2.53 (0.35) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1436.74 (311.48) at baseline and 1378.35 (320.68) at 24 hours. In the dobutamine group heart rate (beats/min) was 84.28 (2.18) at baseline and 96.02 (9.10) after 24 hours; mean arterial pressure (mm Hg) was 83.59 (9.05) at baseline and 74.29 (6.33) at 24 hours; cardiac index (L/min/m2) was 2.16 (0.28) at baseline and) 3.02 (0.34) at 24 hours; systemic vascular resistance (dyn/sec-1/cm-5) was 1578.93 (334.88) at baseline and 1136.68 (158.60) at 24 hours. We found that mean arterial pressure and both systemic and pulmonary vascular resistance decreased significantly in the levosimendan group (P<0.05), but not in the dobutamine group. On the other hand, both heart rate and cardiac index increased in the levosimendan group only (P<0.05). We conclude that levosimendan improves hemodynamic stability in patients who have undergone cardiac surgery and that it is a good alternative for treating postoperative low cardiac output syndrome