Key result
Levosimendan linked to ~6-point higher LVEF and aids ventilator weaning after prior failures.
Why the study?
Mechanically ventilated patients with left ventricular dysfunction are at risk of weaning failure, prompting investigation into whether optimizing cardiovascular function with levosimendan facilitates weaning.
Does levosimendan improve cardiovascular function and facilitate weaning in mechanically ventilated patients with LV dysfunction who are difficult to wean?
Observational (n=19)
No
Does levosimendan improve cardiovascular function and facilitate weaning in mechanically ventilated patients with LV dysfunction who are difficult to wean?
Levosimendan may facilitate successful weaning from mechanical ventilation in difficult-to-wean patients with LV dysfunction by improving systolic and diastolic function.
Answers are grounded in this paper and cite their sources.
May support weaning in LV dysfunction; hypothesis-generating and requires randomized confirmation before practice change.
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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Kaltsi et al. (2019) conducted an observational in Left ventricular systolic dysfunction and difficult weaning from mechanical ventilation (n=19). Levosimendan vs. Baseline (First spontaneous breathing trial prior to levosimendan) was evaluated on Left ventricular ejection fraction (LVEF) measured at the end of the spontaneous breathing trial (p=0.01).
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