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Effects of levosimendan started 24 hours before cardiopulmonary bypass in patients admitted to the ICU with an ejection fraction lower than 30%
Critical Care volume 13, Article number: P167 (2009)
Patients with poor left ventricular function require inotropic drug support after cardiopulmonary bypass (CPB). The use of levosimendan in these patients is associated with a better postoperative function . A recent study has attributed this phenomenon to preconditioning effects of levosimendan . However, a recent study showed no benefit in starting levosimendan before CPB . We hypothesized that admitting the patient to intensive care 24 hours before CPB and starting levosimendan preoperatively could reduce postoperative cardiac damage.
Fifty patients with an ejection fraction less than 30% scheduled for elective cardiac surgery with CPB received anesthesia with propofol, cisatracurium and sufentanil. The patients were randomly assigned to two protocols. Group A: levosimendan 0.1 μg/kg/minute started before CPB after induction + dobutamine 5 μg/kg/minute started after the release of the Aox. Group B: levosimendan 0.1 μg/kg/minute started on the ICU 24 hours before CPB + dobutamine 5 μg/kg/minute started after the release of the Aox. Data analysis: SV, dobutamine, noradrenaline time and dose, cardiac enzymes, global hemodynamic variables, ICU and hospital length of stay. Statistical significance was accepted at P 0.05.
There was no difference in postoperative stroke volume and troponin I. The incidence of postoperative atrial fibrillation in both groups was very low. There was a significant difference in ICU length of stay but not in hospital length of stay.
In cardiac surgery patients with a low preoperative ejection fraction there is no difference in cardiac function and postoperative troponin I levels between the two different levosimendan treatment modalities. The incidence of postoperative atrial fibrillation is low when levosimendan is used perioperatively. There is a significant reduction in the ICU length of stay, but not in the hospital length of stay.
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Duchateau, J., Eede, H.V. Effects of levosimendan started 24 hours before cardiopulmonary bypass in patients admitted to the ICU with an ejection fraction lower than 30%. Crit Care 13, P167 (2009). https://doi.org/10.1186/cc7331
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