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Comparison of norepinephrine, dopamine and dobutamine combined with enteral nutrition in the treatment of elderly patients harboring sepsis.
Zhou, WJ, Cui, JK, Liu, M, Shang, XK, Ding, SS
Pakistan journal of pharmaceutical sciences. 2021;(3):957-961
Abstract
The present study was performed in order to investigate the safety and efficacy of different vasoactive drugs combined with enteral nutrition in terms of treating elderly patients with sepsis. A total of 75 elderly patients with sepsis treated with enteral nutrition in our hospital were randomly divided into three groups: group A (n = 25), group B (n = 25) and group C (n = 25). The three groups were treated with dopamine, dobutamine and norepinephrine respectively. One week after treatment, the therapeutic effects of the three groups were compared, the vascular elastic indexes, hemodynamic indexes and levels of inflammatory factors of the three groups were measured. After treatment, the clinical effective rate of group C was evidently higher than that of group A and group B. The vascular elasticity coefficient and stiffness coefficient in group C were significantly lower than those in group A and group B, and the arterial compliance in group C was significantly higher than that in group A and group B (P < 0.05). The levels of MAP and PVRI in group C were significantly higher than those in group A and B, and the levels of CI, CVP and HR in group C were significantly lower than those in group A and group B (P < 0.05). Norepinephrine elicited greater effects in terms of improving hemodynamic indexes, vascular elasticity and reducing the level of inflammatory factors compared with dopamine and dobutamine in elderly patients harboring sepsis.
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Prevention of Low Cardiac Output Syndrome After Pediatric Cardiac Surgery: A Double-Blind Randomized Clinical Pilot Study Comparing Dobutamine and Milrinone.
Cavigelli-Brunner, A, Hug, MI, Dave, H, Baenziger, O, Buerki, C, Bettex, D, Cannizzaro, V, Balmer, C
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2018;(7):619-625
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Abstract
OBJECTIVES Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients. DESIGN Prospective, single-center, double-blinded, randomized clinical pilot study. SETTING Tertiary-care university children's hospital postoperative pediatric cardiac ICU. PATIENTS After written consent, 50 consecutive patients (age, 0.2-14.2 yr; median, 1.2 yr) undergoing open-heart surgery for congenital malformations were included. INTERVENTIONS After cardiopulmonary bypass, a continuous infusion of either dobutamine or milrinone was administered for the first 36 postoperative hours. Maximum dose: dobutamine 6 µg/kg/min, milrinone 0.75 µg/kg/min. MEASUREMENTS AND MAIN RESULTS There were no significant differences in demographic data, complexity of surgery, and intraoperative characteristics between the two study groups (dobutamine vs milrinone). Efficacy was defined as need for additional vasoactive support, which did not differ between groups (dobutamine 61% vs milrinone 67%; p = 0.71). Sodium nitroprusside was used more often in the dobutamine group (42% vs 13%; p = 0.019). Systolic blood pressure showed a trend toward higher values in the dobutamine group, whereas both drugs increased heart rate early postoperatively. Echocardiography demonstrated a consistently good cardiac function in both groups. Central venous oxygen saturation, serum lactate levels, urine output, time to chest tube removal, length of mechanical ventilation, ICU, and hospital stay were similar in both groups. Both drugs were well tolerated, no serious adverse events occurred. CONCLUSIONS Dobutamine and milrinone are safe, well tolerated, and equally effective in prevention of low cardiac output syndrome after pediatric cardiac surgery. The hemodynamic response of the two drugs is comparable. In uncomplicated cases, a trend toward the more cost-saving dobutamine might be anticipated; however, milrinone demonstrated a trend toward higher efficacy in afterload reduction.
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Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double-Blind Controlled Trial.
Lannemyr, L, Ricksten, SE, Rundqvist, B, Andersson, B, Bartfay, SE, Ljungman, C, Dahlberg, P, Bergh, N, Hjalmarsson, C, Gilljam, T, et al
Journal of the American Heart Association. 2018;(16):e008455
Abstract
Background The management of the cardiorenal syndrome in advanced heart failure is challenging, and the role of inotropic drugs has not been fully defined. Our aim was to compare the renal effects of levosimendan versus dobutamine in patients with heart failure and renal impairment. Methods and Results In a randomized double-blind study, we assigned patients with chronic heart failure (left ventricular ejection fraction <40%) and impaired renal function (glomerular filtration rate <80 mL/min per 1.73 m2) to receive either levosimendan (loading dose 12 μg/kg+0.1 μg/kg per minute) or dobutamine (7.5 μg/kg per minute) for 75 minutes. A pulmonary artery catheter was used for measurements of systemic hemodynamics, and a renal vein catheter was used to measure renal plasma flow by the infusion clearance technique for PAH (para-aminohippurate) corrected by renal extraction of PAH . Filtration fraction was measured by renal extraction of chromium ethylenediamine tetraacetic acid. A total of 32 patients completed the study. Following treatment, the levosimendan and dobutamine groups displayed similar increases in renal blood flow (22% and 26%, respectively) with no significant differences between groups. Glomerular filtration rate increased by 22% in the levosimendan group but remained unchanged in the dobutamine group ( P=0.012). Filtration fraction was not affected by levosimendan but decreased by 17% with dobutamine ( P=0.045). Conclusions In patients with chronic heart failure and renal impairment, levosimendan increases glomerular filtration rate to a greater extent than dobutamine and thus may be the preferred inotropic agent for treating patients with the cardiorenal syndrome. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 02133105.
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Acute effects of levosimendan and dobutamine on QRS duration in patients with heart failure.
Yontar, OC, Yilmaz, MB, Yalta, K, Erdem, A, Tandogan, I
Arquivos brasileiros de cardiologia. 2010;(6):738-42
Abstract
BACKGROUND Levosimendan is a novel inotropic agent that enhances cardiac contractility without increasing cellular calcium intake, so that it is not supposed to cause intracellular calcium overload and related arrhythmias. In patients with heart failure, prolonged QRS duration is associated with increased risk of mortality and sudden cardiac death. Structural changes in the left ventricle may lead to asynchronous contraction, causing conduction delay and a prolonged QRS on the surface electrocardiogram. OBJECTIVE We aimed to compare the acute effects of levosimendan and dobutamine on QRS duration in patients with severe heart failure and sinus rhythm. METHODS Sixty consecutive patients with ischemic heart failure were enrolled for the study and randomized into two groups for levosimendan (n=37) or dobutamine (n=23) infusions. 67.2 % were male; mean age was 66.4 ± 9.2 years for all patients. Baseline QRS durations in levosimendan and dobutamine groups were, 120.44 ± 23.82 ms vs 116.59 ± 13.80 ms respectively. Baseline ejection fractions were both depressed (23.15 ± 8.3% vs 24.56 ± 7.5%). RESULTS In the levosimendan group, QRS duration shortened from baseline value to 116.47 ± 24.56 msec (p=0.006), whereas dobutamine group showed no significant change (p=0.605). Both drugs caused an increase in ejection fraction, but only the levosimendan group showed significance (27.95 ± 8.9% p=0.003 vs 26.67 ± 7.6%, p=0.315). CONCLUSION We suggest that the administration of levosimendan, not dobutamine, shortens QRS duration on the surface ECG, possibly by means of providing collective contraction in the left ventricle muscle fibers. The molecular basis of this effect remains to be clarified.
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Dobutamine-induced spontaneous rhythmic contractions of human isolated atrial strips mimic physiological responses of intact human heart.
Yenisehirli, A, Elalmis, OA
Methods and findings in experimental and clinical pharmacology. 2010;(8):565-73
Abstract
We have shown that in isolated human atrial strips the β1-adrenoceptor agonist dobutamine can induce spontaneous, stable and durable rhythmic contractions. The amplitude and frequency of these contractions were regulated endogenously by the tissue. We tested whether the spontaneously contracted atrial strips could be used as an experimental assay model to determine inotropic and chronotropic effects of existing drugs and candidate chemicals directly on human heart muscle. The well-established inotropic and chronotropic effects of the calcium channel blocker (verapamil), the β-adrenoceptor blocker (propranolol), the phosphodiesterase inhibitor (theophylline) and the Na(+)/K(+)-ATPase inhibitor (ouabain) were tested on spontaneously contracting strips of human atrium. With demonstrative tracings, we showed the negative inotropic and chronotropic effects of verapamil and propranolol, the positive inotropic and chronotropic effects of theophylline and the transient inotropic and tachyarrhythmic effects of ouabain on dobutamine-pretreated human atrial strips. By using this method the undetermined inotropic and chronotropic effects of any candidate compound can be evaluated directly on spontaneously contracting human atrial muscle. Furthermore, we demonstrated the advantages of using dobutamine instead of conventional electrical field stimulation in order to obtain stable and durable contractions of the atrial strips. In conclusion, we describe a new, simple, reliable, convenient and ethical method for investigating the inotropic and chronotropic effects of candidate drugs directly on human atrium tissue without the need for human test subjects.
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Effect of levosimendan on E/E' ratio in patients with ischemic heart failure.
Duygu, H, Ozerkan, F, Nalbantgil, S, Zoghi, M, Akilli, A, Akin, M, Nazli, C, Ergene, O
International journal of cardiology. 2008;(2):201-3
Abstract
BACKGROUND Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E' ratio as a non-invasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner. METHODS Patients with an LVEF < 40% admitting with acute heart failure attack with ischemic origin were included to this study. Patients were randomized to levosimendan (n=30, mean age: 64+/-10 years, 63% male) or dobutamine (n=32, mean age: 66+/-8 years, 54% male) groups. The ratio of the peak E wave velocity taken from mitral inflow with PW Doppler to the peak E' wave velocity taken from mitral lateral annulus with tissue Doppler was determined. Pre-treatment and 24-hour after the treatment E/E' ratios were calculated and then compared in both groups. RESULTS Age, gender, concomitant medications were similar in both groups (p>0.05). There was no difference for pre-treatment baseline E/E' ratios between levosimendan and dobutamine groups (15.7+/-4.0 vs 15.2+/-7.5 respectively, p=0.1). There were significant reductions in post-treatment E/E' ratios in levosimendan (15.7+/-4.0 vs 9.3+/-2.8, p=0.01) and dobutamine groups (15.2+/-7.5 vs 12.9+/-5.6, p=0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p=0.01). CONCLUSIONS Levosimendan causes a greater reduction of E/E' ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure.
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[The calcium sensitizer levosimendan gives superior results to dobutamine in postoperative low cardiac output syndrome].
Levin, RL, Degrange, MA, Porcile, R, Salvagio, F, Blanco, N, Botbol, AL, Tanus, E, del Mazo, CD
Revista espanola de cardiologia. 2008;(5):471-9
Abstract
INTRODUCTION AND OBJECTIVES The use of levosimendan to treat postoperative low cardiac output syndrome (LCOS) has been studied in only small patient series and in randomized trials focusing on hemodynamic variables. The objective of the present study was to assess the effectiveness of levosimendan, compared with dobutamine, as a treatment for postoperative LCOS. METHODS Patients with LCOS were randomly assigned to receive either levosimendan (loading dose, 10 microg/kg, followed by 0.1 microg/kg per min for 24 h) or dobutamine (starting dose, 5 microg/kg per min). Hemodynamic and clinical parameters (including postoperative mortality and major complications), the need for the coadministration of another drug (such as an inotrope or a vasopressor) or for balloon counterpulsation, and length of stay in intensive care were all monitored. RESULTS The study included 137 patients: 69 received levosimendan, while 68 were treated with dobutamine. Although both agents improved hemodynamic parameters, the effect of levosimendan was greater and occurred earlier than that of dobutamine. In addition, levosimendan use resulted in lower postoperative mortality (8.7% vs. 25%; P< .05), a lower incidence of major postoperative complications, and less need for an additional inotropic drug (8.7% vs. 36.8%; P< .05), a vasopressor (11.6% vs. 30.9%; P< .05), or balloon counterpulsation (2.9% vs. 14.7%; P<0.05). The length of stay in intensive care was also less (66 vs. 158 h; P< .05). CONCLUSIONS In this randomized study, levosimendan proved more effective than dobutamine. Postoperative morbidity and mortality were lower, fewer patients required either an additional inotropic drug, a vasopressor or intra-aortic balloon counterpulsation, and the length of stay in intensive care was shorter.
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[Microcirculation in sepsis and septic shock - therapeutic options?].
Ragaller, M
Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 2008;(1):48-53; quiz 54
Abstract
In severe sepsis and septic shock the severe impairment of the microcirculation is one of the main reasons for tissue hypoxia, multiple organ failure and death. Fast resuscitation of the microvascular blood flow to improve the reduced functional capillary density is necessary. Based scientific evidence, an early haemodynamic stabilisation directed by predefined haemodynamic and metabolic goals and the application of activated protein C (rhAPC) according to the guidelines could be recommended. The specific effects of dobutamine and rhAPC on the microcirculation as well as the effects selective inhibitors of iNOS or vasodilators may be therapeutic options in the future.
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Levosimendan improves renal function in patients with acute decompensated heart failure: comparison with dobutamine.
Yilmaz, MB, Yalta, K, Yontar, C, Karadas, F, Erdem, A, Turgut, OO, Yilmaz, A, Tandogan, I
Cardiovascular drugs and therapy. 2007;(6):431-5
Abstract
BACKGROUND Levosimendan is a relatively new cardiac inotropic agent with calcium sensitizing activity. This study was conducted to investigate the effects of levosimendan (L) and dobutamine (D) on renal function in patients hospitalized with decompensated heart failure (HF). METHOD The present study included 88 consecutive patients hospitalized with acutely decompensated HF (New York Heart Association (NYHA) Class 3-4) requiring inotropic therapy. Patients were randomized 2:1 to either L or D for intravenous inotropic support. Diuretic therapy was kept constant during infusions. Renal function values, including serum creatinine (CR), blood urea nitrogen, 24-h urinary output levels and calculated glomerular filtration rate (GFR) were measured just prior to and 24 h after the infusions in all patients, and 48 and 72 h after the infusions in every second patient in both groups. The pre and post-infusion values of renal function and left ventricular ejection fraction (LVEF) were evaluated. RESULTS LVEF increased significantly in both groups. Those in L showed a significant improvement in calculated GFR after 24 h, whereas those in D showed no significant change (median in change in L:+15.3%, median change in D: -1.33%). Furthermore, in the L group a significant improvement was observed in calculated GFR after 72 h compared to baseline levels, whereas in D no significant change (median change in L:+45.45%, median change in D: +0.09%) was seen. Both agents improved 24-h urinary output. CONCLUSION Levosimendan seems to provide beneficial effects in terms of improvement in renal function compared to dobutamine in patients with heart failure who require inotropic therapy.
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[Comparison of effects of low-dose dopamine and dobutamine in patients with nonoliguric renal failure].
Li, MQ, Shi, ZX, Xu, JY, Zhang, Z, Lu, F, Li, L
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue. 2006;(1):51-3
Abstract
OBJECTIVE To investigate the effects of low-dose dopamine and dobutamine on renal functioning patients with nonoliguric renal failure. METHODS Twenty-nine hemodynamically stable patients with nonoliguric renal failure were enrolled to this study group. Each patient was given 5% glucose (control), dopamine or dobutamine in random order by means of an injection pump every 4 hours. The change in urine output, fractional excretion of sodium (FeNa) and creatinine clearance rate (CCr) were determined. RESULTS Compared with control, urine volume, FeNa, and CCr were increased significantly after administration of dopamine, or dobutamine. Compared with dobutamine, dopamine could increase the urine output and the FeNa markedly, but there was no difference in CCr increase between dopamine and dobutamine. CONCLUSION Dopamine or dobutamine treatment could significantly increase the urine output, FeNa, and CCr in patients with nonoliguric renal failure. Dopamine infusion markedly increases urine output and the FeNa, but there is no significantly difference in CCr between dopamine and dobutamine treatment.