Clinical findings of levosimendan infusion for patients with acute myocardial depression induced by septic shock

Background Acute myocardial depression caused by sepsis is an important cause of early death in sepsis patients.This study aimed to evaluate the effects of levosimendan on septic myocardial depression compared with the control treatment.Methods A single-center study was conducted from Jan 15th 2019 to Jan 20th 2020.A total of 112 patients with septic myocardial depression were included and divided into levosimendan(LEV)group(n=49)and the control group(n=63)based on the administration of levosimendan.Clinical data including heart function,mechanical ventilation time,the length of intensive care unit(ICU)stay,the incidence of acute pulmonary edema and 28-day of survival rates were recorded.Results Compared with the control group,the improvement of left ventricular ejection fraction(LVEF)was greater in LEV group after one week treatment(52.41±4.62 vs.47.32±4.31,P=0.003).The level of N-terminal pro-brain natriuretic peptide(NT-pro-BNP)decreased more significantly(1882.92±190.61 pg/mL vs.3374.62±453.13 pg/mL,P=0.004).The mechanical ventilation time(112.43±9.11 h vs.135.34±12.54 h,P=0.013)and the length of ICU stay were also shorter(10.53±3.32 d vs.16.82±5.24 d,P=0.027)than that in the control group,and the incidence of acute pulmonary edema was lower(9.91%vs.17.22%,P=0.041).However,Kaplan-Meier analysis indicated there was no significant difference in both group for 28-day survival rates.Conclusions Levosimendan can improve cardiac function and shorten the duration of mechanical ventilation and ICU hospitalization for septic shock patients with myocardial depression.

5-Hydroxytryptamine Changes under Different Pretreatments on Rat Models of Myocardial Infarction and/or Depression

Background：Psychocardiological researches have suggested a central role of 5-hydroxytryptamine （5-HT） on psychocardiological mechanism.This study aimed to further explore the central role of 5-HT and pretreatment effects of XinLingWan on rats with myocardial infarction （M I） and/or depression.Methods：Ninety Sprague-Dawley rats were randomly divided into three groups：MI group,depression group,and MI ＋ depression group （n 30 in each group）.Each group was then divided into three subgroups （n =10 in each subgroup）：a negative control subgroup （NCS）,a Western medicine subgroup （WMS）,and a traditional Chinese medicine subgroup （TCMS）,which were received pretreatment once a day for 4 weeks by saline,20 mg/kg sertraline mixed with 2 ml saline,and 40 mg/kg XingLingWan mixed with 2 ml saline,respectively.Different rat models were established after different pretreatments.Rats were then sacrificed for detection of serum 5-HT,platelet 5-HT,5-HT2.A receptors （5-HT2AR）,and serotonin transporter （SERT）.Data were analyzed by one-way analysis of variance （ANOVA） and least-significant difference （LSD） testing.Results：M I group：compared with NCS,there was a significant increase in WMS and TCMS of serum 5-HT （176.15 ± 11.32 pg/ml vs.334.50 ± 29.09 pg/ml and 474.04 ± 10.86 pg/ml,respectively,both P =0.000）,platelet 5-HT （129.74 ± 27.17 pg/ml vs.322.24 ± 11.60 pg/ml and 340.4 5 ± 17.99 pg/ml,respectively,both P =0.000）;depression group：compared with NCS,there was a significant increase in WMS and TCMS of serum 5-HT （194.69 ± 5.09 pg/ml vs.326.21 ± 39.98 pg/ml and 456.33 ± 23.12 pg/ml,respectively,both P =0.000）,platelet 5-HT （175.15 ± 4.07 pg/ml vs.204.56 ± 18.59 pg/ml and 252.03 ± 22.26 pg/ml,respectively,P =0.004 and P 0.000,respectively）;MI ＋ depression group：compared with NCS,there was a significant increase in both WMS and TCMS of serum 5-HT （182.50 ± 10.23 pg/ml vs.372.55 ± 52.23 pg/ml and 441.76 ± 23.38 pg/ml,respectively,both P =0.000） and platelet 5-HT （180.83 ± 11.08 pg/ml vs.221.12 ± 22.23 pg/ml and 265.37 ± 29.49 pg/ml,respectively,P =0.011 and P =0.000,respectively）.Conclusions：By elevating the amount of 5-HT and modulating 5-HT2AR and SERT levels in serum and platelets,XinLingWan and sertraline were found to exert pretreatment effect on rat models of MI and/or depression.

Efficacy and Safety of Esmolol in Treatment of Patients wi Septic Shock

Background： Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. Methods： Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate （HR） 〉100 beats/rain. Esmolol therapy achieved the target HR of 10-15% lower than the baseline HR. Clinical and physiological data of patients were collected prospectively within 1 h prior to esmolol therapy and 2 h after achieving the targeted HR. Results： Sixty-three patients were recruited. After esmolol therapy, blood pressure was unaltered, whereas stroke volume （SV） was increased compared with betbre esmolol therapy （43.6 ± 22.7 vs. 49.9 ±23.7 ml, t = -2.3, P = 0.047）. Tissue perfusion, including lactate levels （1.4 ± 0.8 vs. 1.1 ± 0.6 mmol/L, t = 2.6, P = 0.015） and the central venous-to-arterial carbon dioxide difference （5.6 ±3.3 vs. 4.3 ± 2.2 mmHg, t - 2.6 P = 0.016）, was also significantly decreased after esmolol therapy. For patients with increased SV （n = 42）, cardiac efficiency improved, and esmolol therapy had a lower risk for a decrease in cardiac output （CO）. Therefore, pretreatment cardiac systolic and diastolic parameters with （n = 42）/without 01 = 21 ） an increase in SV were compared. Mitral lateral annular plane systolic excursion （MAPSEIat） in patients with increased SV was significantly higher than that in those without increased SV （1.3 ±0.3 vs. 1.1 ± 0.2 cm, t = 2.4, P = 0.034）. Conclusions： SV of septic shock patients is increased is llowing esmolol therapy. Although CO is also decreased with HR, tissue perfusion is not worse.

Unstable cardiac injury complicated with septic shock—a challenge

Background:Road traffic accident accounts for 70%to 80%of the blunt cardiac injury.The true incidence varies in the literature due to non-uniform criteria for diagnosis.Case Presentation:Here,we describe the case of a young male presenting after blunt chest injury and hemodynamic instability.Initially,the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se.However,he was stabilized by day 2.Subsequently,patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury.Conclusion:Sepsis is difficult to be diagnosed and treated in the presence of cardiac injury.Myocardial depression has been found in sepsis,which contributes as an added comorbidity in an already compromised heart function.Sepsis also interferes with the diagnosis and follow-up of progress of blunt cardiac injury.