The use of levosimendan in shocked patients with compromised left ventricular function and requiring catecholamine support – A

Objective: Levosimendan is a calcium sensitizer that improves cardiac contractility without increasing intracellular calcium level, hence energy demand. Theoretically, it is safer to use levosimendan than catecholamine in shocked patients who require inotrope support. Studies on the use of levosimendan in shocked patients are, however, limited. In this case series, we describe the pre- and post-infusion effects of levosimendan in shocked patients with reduced cardiac function and requiring catecholamine inotrope support. Design: A case-series report. Setting: The intensive care unit of a teaching hospital. Patients: Fifteen shocked patients with reduced left ventricular ejection fraction and requiring catecholamine inotrope support were reviewed retrospectively. Intervention: 24 hour intravenous infusion of levosimendan with concomitant noradrenaline infusion. Results: In response to 24-h levosimendan infusion, the left ventricular ejection fraction increased from 25.7 ± 11.0% to 29.8 ± 8.6% (P = 0.0389), and the plasma B-type natriuretic peptide reduced from 993 ± 389 to 644 ± 408 pg/ml (P = 0.0015). The blood lactate also demonstrated a significant decrease. During infusion, the mean arterial blood pressure (MAP) was maintained above 65 mmHg by concomitant noradrenaline infusion. The noradrenaline dosages required to maintain the MAP were reduced at the end of infusion. No adverse event related to the drug was seen during the infusion. Conclusion: Levosimendan leads to an improvement in the hemodynamic status of the shocked patients with compromised left ventricular function. This improvement was reflected by an improvement in LVEF, the favorable changes in BNP and blood lactate levels. Levosimendan is safe to use and may present an alternative to catecholamine inotropes in the management of shocked patients with reduced cardiac function and requiring inotrope support.