Levosimendan: experience of an adult ICU

Introduction

The prognosis of patients admitted to the ICU with cardiogenic shock is poor.

Method

Data were collected retrospectively between January 2004 and June 2005. Cardiac studies and inotrope use were evaluated using Wilcoxon matched-pairs testing.

Results

Twenty-eight patients received levosimendan. Ten (34%) patients were admitted following cardiac surgery and nine (31%) post acute myocardial infarction. The mean APACHE II score at time of levosimendan was 19 (SE = 0.96). No patients received a loading dose. The median maintenance dose was 0.1 μg/kg/min for a median of 24 hours (range = 3–58). A reduction in the mean dose of dobutamine (8.26 vs 3.77 μg/kg/min, n = 7, P = 0.031) and milrinone (0.22 vs 0.12 μg/kg/min, n = 8, P = 0.031) was seen 24 hours post levosimendan. A single patient developed atrial fibrillation and there were no new reports of ischaemia. ICU mortality was 62%.

Discussion

Levosimendan had a favourable impact on the cardiac index, systemic vascular resistance index and inotrope use in our critically ill ICU patients at high risk of death. It was well tolerated in terms of arrhythmias and cardiac ischaemia.

Figure 1

Levosimendan increases the cardiac index (CI) while lowering the systemic vascular resistance index (SVRI).

Table 1