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 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 mu g/kg/min (n = 10), or dobutamine 5 mu g/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

Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin

AbstractWe describe a case of 58-year-old man with septic shock due to Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) bloodstream infections (BSI) who was successfully treated with a high dose association of amikacin and imipenem combined with continuous venovenous hemodiafiltration (CVVHDF).A Klebsiella pneumoniae (Kp) was isolated from the catheter culture and from two blood samples, drawn from the catheter before removal and from a peripheral vein. The Kp was intermediate to Amikacin (MIC=16μg/ml) and was resistant to all other antibiotics including Imipenem (MIC=4μg/ml), Colistin (MIC=16μg/ml) and Tigecycline (MIC=4μg/ml) according to the Clinical and Laboratory Standards Institute (CLSI) published in 2011. PCR amplification and sequencing verified the presence of blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV-1 genes.Amikacin was given at a dose of 30mg/kg (2.5g) in a 30min infusion and the dose of imipenem was increased to 1g every 6h despite patient's altered renal function (Creatinine Clearance=25ml/min). To avoid amikacin nephrotoxicity and to allow the use of high doses of imipenem, continuous venovenous hemodiafiltration (CVVHDF) (blood flow, 200ml/h; dialysate, 1000ml/h; ultrafiltrate, 2000ml/h) was initiated 1h after the start of the amikacin infusion and continued thereafter.The patient improved hemodynamically and norepinephrine was stopped five days after antibiotherapy adaptation

Effect of Ondansetron on the Occurrence of Hypotension and on Neonatal Parameters during Spinal Anesthesia for Elective Caesarean Section: A Prospective, Randomized, Controlled, Double-Blind Study

To prevent hypotension during spinal anesthesia for caesarean section, we assessed IV ondansetron of invasive maternal hemodynamic and fetal gazometric parameters