Abstract: Poster Presentations |

Hemodynamic Effects of Nitroglycerin and Levosimendan During Difficult Weaning FREE TO VIEW

Nektaria N. Papadopoulou, MD; Nikolaos D. Manolakoglou, MD; Ioannis T. Stanopoulos, MD
Author and Funding Information

RFU Unit, General Hospital, Thessaloniki, Greece


Chest. 2003;124(4_MeetingAbstracts):206S-b-207S. doi:10.1378/chest.124.4_MeetingAbstracts.206S-b
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PURPOSE:  The aim of our study was to pharmaceutically reduce preload and afterload in a group of difficult to wean MICU patients (pts) during transition from mechanical ventilation (MV) to spontaneous breathing.

METHODS:  8 male pts were studied. All of them were catheterized with a Swan Ganz catheter, after following at least 2 unsuccessful T-piece trials on 2 consecutive days. Hemodynamic and blood-gas parameters were monitored before (pressure-support mode) and during the first 10’ of the T-piece trial. In 4 pts (2 COPD with CHF and 2 IPF with cor pulmonale - called N group) an IV infusion of nitroglycerin was started, titrated to maintain a normal blood pressure, while in 4 pts (4 COPD with CHF), a 24-hour infusion of levosimendan was started (L group). Measurements were repeated in 60’ of the T-piece trial.

RESULTS:  Pts hemodynamics are shown in tables 1


T piece 10’T piece 60’Pw14,5 +/− 7,512 +/− 4,61mBP91 +/− 23,0380 +/− 10,39mPAP46,5 +/− 0,5735 +/− 3,46* * p=0,015CO5,8 +/− 0,86,85 +/− 0,05DO2763 +/− 322962 +/− 295∼ ∼p=0,017VO2248 +/− 104,5317 +/− 104,5and 2


T piece 10’Tpiece 60’Pw21,5 +/− 2,8814,5 +/− 8,66* *p=0,0014mBP86 +/− 9,2378,5 +/− 4,04mPAP39 +/− 5,7727 +/− 6,92∼ ∼p=0,0002CO8,05 +/− 1,449,45 +/− 4,21DO21050 +/− 2371321 +/− 692VO2359,5 +/− 66,39396 +/− 123,55Image not availableImage not availablep=0,007. 2 pts of the N group were successfully extubated, while in 2 MV was resumed (new infection). All 4 pts of the L group were successfully extubated, while 2 were reintubated (GI bleeding, new infection).Comparison between the 2 drugs showed a more pronounced effect for levosimendan in lowering Pw (p=0,0002) and VO2 (p=0,015).

CONCLUSION:  Hemodynamic improvement by nitroglycerin or levosimendan may facilitate weaning in pts with a low cardiopulmonary reserve.

DISCLOSURE:  N.N. Papadopoulou, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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