The effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock

Abstract

Background: Septic shock is the leading causes of death in intensive care units. In addition to generous fluid administration, inotropic agents are commonly used to improve cardiac output. The effects of inotropic agents on regional blood flow remains unknown.

Objective: The aim of this study was to assess the effects of levosimendan vs dobutamine added to dopamine on liver functions assessed using noninvasive liver function monitoring (LiMON) in patients with septic shock.

Design: Prospective analysis.

Measurements and results: We analyzed 30 patients with septic shock who were treated in an intensive care unit. Indocyanine green plasma disappearance rate (ICG-PDR) was conducted concurrently using the LiMON system. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus.

Results: Statistical analysis showed that the variation of hemodynamic variables was different between groups. In our results, the increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure was significantly higher in levosimendan group than in dobutamine group (P < .05). There was a decrease in before- and after-infusion ICG-PDR values in dobutamine group (20.38 ± 4.83 vs 20.34 ± 5.30), and no statistical difference was detected (P = .649). There was an increase in before- and after-infusion ICG-PDR values in levosimendan group (18.70 ± 2.59 vs 21.65 ± 3.20), and a statistical difference was detected (P = .001). There was statistical difference between groups (P = .000).

Conclusion: These results suggest that levosimendan added to dopamine improves systemic hemodynamics and increases splanchnic perfusion assessed using the user-friendly noninvasive bedside system LiMON in patients with septic shock compared with dobutamine.