OBJECTIVE: To evaluate the role of levosimendan in improving cardiac performance and the success rate of weaning from mechanical ventilation in ventilatordependent, difficult-to-wean patients with impaired cardiac function in the intensive care unit. DESIGN AND SETTING: Prospective, observational study in the ICU of Westmead Hospital, a university-affiliated tertiary referral hospital in Sydney, NSW, between January 2003 and October 2004. PATIENTS AND INTERVENTIONS: 47 ICU patients who were ventilator-dependent for > or =10 days and had failed a weaning or extubation attempt due to respiratory insufficiency were identified as difficult to wean from mechanical ventilation. All were assessed by transthoracic or transoesophageal echocardiography. Twelve who had impaired left ventricular performance (demonstrated by left ventricular ejection fraction [LVEF] <40%) and were already established on diuretic and vasodilator treatment were given a 24-hour infusion of levosimendan. LVEF was measured again within 24 hours after infusion, and weaning from mechanical ventilation and extubation were re-attempted, when clinically deemed feasible. RESULTS: Levosimendan administration was associated with significantly improved LVEF (28.3% before v 34.6% after, P=0.04) and PaO2/FIO2 ratio (179mmHg v 197mmHg, P=0.002) and reduced FIO2 (0.45 v 0.39, P=0.01). These changes were associated with significant improvement in the success rate in weaning from mechanical ventilation (P=0.02), with seven of the 12 patients successfully weaned after levosimendan therapy, and six surviving to hospital discharge. There was no significant difference in any other important parameter between pre- and post-levosimendan weaning attempts. CONCLUSIONS: Levosimendan may provide significant benefit to ventilator-dependent patients with impaired left ventricular function. Randomised controlled trials appear justified.
OBJECTIVE: To evaluate the role of levosimendan in improving cardiac performance and the success rate of weaning from mechanical ventilation in ventilatordependent, difficult-to-wean patients with impaired cardiac function in the intensive care unit. DESIGN AND SETTING: Prospective, observational study in the ICU of Westmead Hospital, a university-affiliated tertiary referral hospital in Sydney, NSW, between January 2003 and October 2004. PATIENTS AND INTERVENTIONS: 47 ICU patients who were ventilator-dependent for > or =10 days and had failed a weaning or extubation attempt due to respiratory insufficiency were identified as difficult to wean from mechanical ventilation. All were assessed by transthoracic or transoesophageal echocardiography. Twelve who had impaired left ventricular performance (demonstrated by left ventricular ejection fraction [LVEF] <40%) and were already established on diuretic and vasodilator treatment were given a 24-hour infusion of levosimendan. LVEF was measured again within 24 hours after infusion, and weaning from mechanical ventilation and extubation were re-attempted, when clinically deemed feasible. RESULTS:Levosimendan administration was associated with significantly improved LVEF (28.3% before v 34.6% after, P=0.04) and PaO2/FIO2 ratio (179mmHg v 197mmHg, P=0.002) and reduced FIO2 (0.45 v 0.39, P=0.01). These changes were associated with significant improvement in the success rate in weaning from mechanical ventilation (P=0.02), with seven of the 12 patients successfully weaned after levosimendan therapy, and six surviving to hospital discharge. There was no significant difference in any other important parameter between pre- and post-levosimendan weaning attempts. CONCLUSIONS:Levosimendan may provide significant benefit to ventilator-dependent patients with impaired left ventricular function. Randomised controlled trials appear justified.