Use of levosimendan in critically ill patients with severe aortic stenosis and left ventricular dysfunction

Caetano, Francisca; Mota, Paula; Barra, Sérgio; Almeida, Inês; Botelho, Ana; Trigo, Joana; Marques, António Leitão

doi:10.1177/2048872612467294

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…BNP-driven or physician-driven fluid managementFurosemide ( loop of Henle diuretic ) ± Acetazolamide sodium ( carbonic anhydrase inhibitor )Fluid overloadMore negative fluid balance in BNP-guided groupShorter duration of MV in BNP-guided approach. Strongest effect in patients with LV systolic dysfunctionCateano et al [89]1Aortic stenosis, LV systolic dysfunctionLevosimendan ( Calcium sensitizer ) 0.1 µg/kg/min × 24 hLV systolic dysfunctionLV systolic function and mean aortic gradient increasedSuccessfully weanedMongodi et al [56]1COPD, arterial hypertension, rheumatoid arthritisRamipril ( angiotensin - converting enzyme inhibitors ) 2.5 mg/die, Nebivolol ( beta - blockers ) 5 mg/die)and mild negative water balanceLV diastolic dysfunction, LUS consistent with increased EVLWReduced LV filling pressures and normal LUSSuccessfully weaned a Randomized control trial, COPD chronic obstructive pulmonary disease, RV right ventricular, LV left ventricular, PAOP pulmonary artery occlusion pressure, PAP pulmonary artery pressure, PVR pulmonary vascular resistance, LVEF left ventricular injection fraction, RV right ventricular, SBT spontaneous breathing trial, INO inhaled nitric oxide, BNP B-type natriuretic peptide, EVLW extravascular lung water, LUS lung ultrasound…”

Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

“…The clinical benefits of levosimendan in difficult-to-wean patients because of cardiovascular dysfunction have been highlighted in few reports [17, 83, 87–89]. Levosimendan was given in ventilator-dependent patients with impaired LV function, who had failed a SBT or extubation attempt, and were already under diuretic and vasodilator treatment.…”

Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

“…All included patients were ultimately extubated without the adjunct of any other cardiovascular drug. Lastly, use of levosimendan effectively contributed to successful weaning in difficult-to-wean patients with impaired LV function in a study available only in an abstract form [87] as well as in single patients with LV dysfunction of various etiologies [88, 89].…”

Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

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Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Routsi¹,

Stanopoulos²,

Kokkoris³

et al. 2019

Ann. Intensive Care

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Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. In this review, we summarize the contemporary evidence of the most important clinical and diagnostic aspects of weaning failure of cardiovascular origin with special focus on treatment. Pathophysiological mechanisms are complex and mainly include increase in right and left ventricular preload and afterload and potentially induce myocardial ischemia. Patients at risk include those with preexisting cardiopulmonary disease either known or suspected. Clinically, cardiovascular etiology as a predominant cause or a contributor to weaning failure, though critical for early diagnosis and intervention, may be difficult to be recognized and distinguished from noncardiac causes suggesting the need of high suspicion. A cardiovascular diagnostic workup including bedside echocardiography, lung ultrasound, electrocardiogram and biomarkers of cardiovascular dysfunction or other adjunct techniques and, in selected cases, right heart catheterization and/or coronary angiography, should be obtained to confirm the diagnosis. Official clinical practice guidelines that address treatment of a confirmed weaning-induced cardiovascular dysfunction do not exist. As the etiologies of weaning-induced cardiovascular dysfunction are diverse, principles of management depend on the individual pathophysiological mechanisms, including preload optimization by fluid removal, guided by B-type natriuretic peptide measurement, nitrates administration in excessive afterload and/or myocardial ischemia, contractility improvement in severe systolic dysfunction as well as other rational treatment in specific indications in order to lead to successful weaning from mechanical ventilation.

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Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

See 1 more Smart Citation

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Routsi¹,

Stanopoulos²,

Kokkoris³

et al. 2019

Ann. Intensive Care

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“…Additionally, use of levosimendan effectively contributed to successful weaning in a patient with dilated cardiomyopathy after repeated weaning failures [24], as well as in another case [40].…”

Section: Discussionmentioning

confidence: 99%

Contribution of Levosimendan in Weaning from Mechanical Ventilation in Patients with Left Ventricular Dysfunction: A Pilot Study

Kaltsi

Angelopoulos

Tzanis

et al. 2019

Critical Care Research and Practice

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Purpose. Mechanically ventilated patients with left ventricular (LV) dysfunction are at risk of weaning failure. We hypothesized that optimization of cardiovascular function might facilitate the weaning process. Therefore, we investigated the efficacy of levosimendan in difficult-to-wean patients with impaired LV performance. Materials and Methods. Nineteen mechanically ventilated patients, with LV ejection fraction (LVEF) 34 ± 8%, difficult-to-wean from the ventilator, were assessed by transthoracic echocardiography before the start and at the end of a spontaneous breathing trial (SBT) (first SBT). Eight patients successfully weaned. The remaining 11 failed-to-wean patients received a 24-hour infusion of levosimendan, and they were reassessed during a second SBT. Results. After levosimendan administration, LVEF increased from 30 ± 10 to 36 ± 3% (p=0.01). End-SBT peak e′ velocity increased from 7 to 9 cm/s (p=0.02). E/e′ increased from 10.5 to 12.9 during the first SBT, whereas it remained constant at 10 throughout the second SBT (p=0.01). During the second SBT, partial pressure of arterial oxygen and central venous oxygen saturation improved, compared to the first one (93 ± 34 vs. 67 ± 28 mmHg, p=0.03, and 66 ± 11% vs. 57 ± 9%, p=0.02, respectively). Nine of the 11 patients were successfully weaned from the ventilator. Conclusions. In difficult-to-wean from mechanical ventilation patients with LV dysfunction, levosimendan might contribute to successful weaning by improving both systolic and diastolic LV function.

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“…There is scarce clinical evidence of the hemodynamic effects of levosimendan in HF patients with acute decompensation, severe AS and reduced LVEF. Some case reports suggest potential beneficial effects of preoperative levosimendan in patients with severe AS and left ventricular dysfunction . Järvelä et al.…”

Section: Discussionmentioning

confidence: 99%

Levosimendan Improves Hemodynamic Status in Critically Ill Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction: An Interventional Study

García-González

Jorge-Pérez

Jiménez-Sosa

et al. 2015

Cardiovascular Therapeutics

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SUMMARYAims: To study the hemodynamic effect of levosimendan administration in acute heart failure patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF). Methods: Hemodynamic response to 24 h intravenous levosimendan infusion (0.1 lg/kg/min without a loading dose) in patients with severe AS (aortic valve area ≤1 cm (P = 0.01). A significant beneficial effect was also observed in pulmonary capillary wedge pressure, pulmonary artery mean pressure, central venous pressure, systemic vascular resistances, pulmonary vascular resistances, stroke volume index, left ventricular stroke work index. NTproBNP levels decreased at 24 h of levosimendan treatment. Levosimendan infusion was also well tolerated. Five patients subsequently underwent aortic valve surgery replacement. One died (of postoperative multiorgan failure). At 30 days, overall survival was 75%. Conclusions: Levosimendan administration improves hemodynamic parameters in critically ill patients with severe AS and reduced LVEF. In our study, it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in surgical contraindicated patients. A controlled study is needed to confirm these preliminary findings.

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Use of levosimendan in critically ill patients with severe aortic stenosis and left ventricular dysfunction

Cited by 6 publications

References 19 publications

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Contribution of Levosimendan in Weaning from Mechanical Ventilation in Patients with Left Ventricular Dysfunction: A Pilot Study

Levosimendan Improves Hemodynamic Status in Critically Ill Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction: An Interventional Study

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