Effect of Ivabradine on Microcirculation and Cardiac Output in Septic Shock Patients
Status:
Not yet recruiting
Trial end date:
2022-02-05
Target enrollment:
Participant gender:
Summary
Persistent tachycardia in sepsis or multi-organ dysfunction syndrome (MODS) is an ominous
sign. This usually comes under control with judicious use of antibiotics, fluid
resuscitation, sedation. Uncontrolled tachycardia in systemic inflammatory response syndrome
and sepsis deprives the heart muscle of oxygen. As it progresses, insufficient heart muscle
nutrition eventually leads to myocardial dysfunction. It can also present as heart failure.
In acute coronary syndromes, beta blockers are used to control heart rate. However in MODS,
it cannot be used due to hemodynamic instability and worsened myocardial function.
Sinoatrial (SA) myocytes are the pacemaker cells in the heart. Pacemaker activity involves
several ionic currents that influences spontaneous depolarization of SA node including I(f)
current. The word I(f) means funny, because this current has unusual properties as compared
with other currents known at the time of its discovery. It is one of the most important ionic
current for regulating pacemaker activity in SA node.
Ivabradine is an I(f) current inhibitor in SA node. Currently, it is the only agent shown to
clinically lower heart rate with no negative inotropism or effects on conduction and
contractility.so usage of Ivabradine to control tachycardia in patients with septic shock may
help to improve myocardial filling and cardiac output.
Marcos L.Miranda et al. found that Ivabradine was effective in reducing microvascular
derangements evoked by experimental sepsis, which was accompanied by less organ dysfunction.
These results suggest that ivabradine yields beneficial effects on the microcirculation of
septic animals.
No data found on effect of Ivabradine on the microcirculation of human. In this study the
investigators will investigate the effect of Ivabradine on perfusion in capillary circulation
using Cytocam video microscope, Braedius®.