Levosimendan in Cardiac Failure After Subarachnoid Hemorrhage

被引:28
作者
Busani, Stefano [1 ]
Rinaldi, Laura [1 ]
Severino, Claudia [1 ]
Cobelli, Milena [3 ]
Pasetto, Alberto [1 ]
Girardis, Massimo [2 ]
机构
[1] Univ Modena & Reggio Emilia, Cattedra & Serv Anestesia & Rianimaz 1, Modena, Italy
[2] Univ Modena & Reggio Emilia, Policlin Modena, Modena, Italy
[3] Policlin Modena, Serv Neuroradiol, Modena, Italy
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2010年 / 68卷 / 05期
关键词
Subarachnoid hemorrhage; Cerebral aneurysm; Shock; Cardiogenic; Myocardial stunning; Inotropic drugs; HEART-FAILURE; DOBUTAMINE; INJURY;
D O I
10.1097/TA.0b013e31817c4284
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The aim of this study is to report the development of cardiac failure after subarachnoid hemorrhage (SAH) with recovery of heart and cerebral function. This is a case report of a 38-year-old woman who was admitted to the intensive care unit (ICU) at Policlinico di Modena, Italy. This woman developed a deep state of coma because of severe SAH. After cerebral hemorrhage, patient showed a cardiogenic shock, which needed invasive monitoring. Cerebral perfusion pressure had to be restored, so fluids, dopamine, norepinephrine, and dobutamine were in administered sequentially. Despite these supportive treatments, hemodynamic parameters further worsened and echocardiography showed a global depressed left ventricular (LV) contraction with poor ejection fraction (EF) and restrictive type of LV relaxation pattern. Twenty-four hours after ICU admission, levosimendan was started with the aim to improve cardiac function because of the refractoriness of all other treatments. Eight hours after levosimendan infusion, cardiac function improved and, within the after 24 hours, EF and LV relaxation pattern recovered. Neurologic state and computed tomography images improved day by day, and after 9 days from the ICU admission, we transferred the patient to the neurosurgical ward with very good neurologic conditions and no deficits in motility. The conventional management of post-SAH cardiovascular failure is based on the use of norepinephrine, dobutamine, and high amount of fluids. This strategy did not provide any improvement, so we decided for levosimendan infusion to counteract myocardial stunning. The improvement in cardiac EF, LV wall motion, and filling pressure observed in our patient could be explained due to the antistunning triple-mechanism action of levosimendan. Data available on the levosimendan effectiveness in patients with SAH and its effect on intracranial pressure are still lacking, but we think that neurogenic cardiac failure can be treated at first with levosimendan.
引用
收藏
页码:E108 / E110
页数:3
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