Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 28;15(6):871.
doi: 10.3390/life15060871.

The Effects of Levosimendan on Microcirculation and Peripheral Perfusion in Septic Shock: A Pilot Study

Veronica Gagliardi  1   2 , Francesco Ceccherelli  2 , Antonello Lovato  2 , Giuseppe Gagliardi  1   2   3
Affiliations

The Effects of Levosimendan on Microcirculation and Peripheral Perfusion in Septic Shock: A Pilot Study

Veronica Gagliardi et al. Life (Basel). .

Abstract

Septic patients can show multiorgan failure even after an apparent recovery of hemodynamic stability. The underlying mechanism is unclear, but the main pathological element is microcirculation impairment, leading to insufficient oxygen delivery. This study aimed to assess the effects of levosimendan administration on peripheral perfusion in the prodromic phases of sepsis and compare them with the variations in microcirculation perfusion occurring with conventional dobutamine therapy. Sixteen patients with sepsis were enrolled, eight of whom were treated with norepinephrine and levosimendan and the other eight with norepinephrine and dobutamine. We observed a trend of reduction in the hematic lactate concentration and an increase in peripheral perfusion in the patients treated with levosimendan. The latter also occurred in the dobutamine group, although to a lower degree. Hematic lactate was significantly reduced in the levosimendan group, probably because of the enhanced aerobic metabolism, due to both the action on mitochondrial KATP channels and the better oxygen delivery to cells. The lactate values varied from T0 (2.28 ± 0.25 mmol/L) to T2 (1.45 ± 0.31 mmol/L) in the levosimendan group vs. from T0 (2.79 ± 0.91 mmol/L) to T2 (2.92 ± 0.76 mmol/) L in the dobutamine group. Hence, levosimendan may be indicated in septic patients with impaired microcirculation and tissue oxygenation and, consequently, high lactate levels. Further studies are needed to draw a profile of levosimendan as a possible treatment to restore microcirculation in septic patients.

Keywords: inodilators; levosimendan; microcirculation; septic shock.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Figures

Figure 1
Figure 1
Timetable.
Figure 2
Figure 2
Laser Doppler fluxmeter.
Figure 3
Figure 3
MAP variations.
Figure 4
Figure 4
SVRI variations.
Figure 5
Figure 5
SvO2 variations.
Figure 6
Figure 6
CI variations.
Figure 7
Figure 7
Lactate variations. Highlighted parts of the bar represent the data above mentioned in the previous paragraph.
Figure 8
Figure 8
Percentage variation in PU at T1 with respect to T0.
Figure 9
Figure 9
Percentage variation in PU at T2 with respect to T0.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Deitch E.A. Multiple organ failure. Pathophysiology and potential future therapy. Ann. Surg. 1992;216:117–134. doi: 10.1097/00000658-199208000-00002. - DOI - PMC - PubMed
    1. Angus D.C., van der Poll T. Severe sepsis and septic shock. N. Engl. J. Med. 2013;369:840–851. doi: 10.1056/NEJMra1208623. Erratum in N. Engl. J. Med. 2013, 369, 2069. - DOI - PubMed
    1. Evans L., Rhodes A., Alhazzani W., Antonelli M., Coopersmith C.M., French C., Machado F.R., Mcintyre L., Ostermann M., Prescott H.C., et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49:e1063–e1143. doi: 10.1097/CCM.0000000000005337. - DOI - PubMed
    1. Hollenberg S.M., Cunnion R.E., Parrillo J.E. Effect of septic serum on vascular smooth muscle: In vitro studies using rat aortic rings. Crit. Care Med. 1992;20:993–998. doi: 10.1097/00003246-199207000-00016. - DOI - PubMed
    1. Pinsky M.R., Matuschak G.M. Cardiovascular determinants of the hemodynamic response to acute endotoxemia in the dog. J. Crit. Care. 1986;1:18–31. doi: 10.1016/S0883-9441(86)80113-7. - DOI

LinkOut - more resources