Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Fig. 1. Meta-analysis of RCTs comparing levosimendan with dobutamine in patients experiencing sepsis-induced cardiac dysfunction. Forest plot of mortality. OR, odds ratio; CI, confidence interval. I2 = 0%, p = 0.99, fixed effects, OR: 0.72, 95% CnI: 0.39–1.33. Figure drawn freely from the data reported by Liu et al. [26]

Fig. 2. Effect of levosimendan in weaning from mechanical ventilation in patients with left ventricular dysfunction. Left ventricular ejection fraction (LVEF) before the start (white boxes) and at the end (grey boxes) of spontaneous weaning trials in successfully weaned patients (left) and in those who failed and received levosimendan (right). LVEF increased after levosimendan administration. Figure drawn freely from the data reported by Kaltsi et al. [40]. SBT, spontaneous breathing trial

Fig. 3. Algorithms for weaning from a extracorporeal membrane oxygenation and b mechanical ventilation which include levosimendan. Figure drawn freely from Sangalli et al. [55] E/A, ratio of early to late (atrial) peak blood flow during diastole; DT, deceleration time; LVEDP, left ventricular end-diastolic pressure

Fig. 4. Mortality data and the incidence of acute kidney injury (AKI) reported for 3641 patients in a cardiac surgery network analysis. P-scores ranking plot showing mortality and AKI associated with interventions. Treatments with better efficacy should be in the upper-right-hand corner of the graph. Figure drawn freely from the data reported by Chen et al. [77]

Fig. 5. Variation of acute kidney injury (AKI) stage after 48 h in patients treated with dobutamine vs levosimendan. *Statistically significant difference. Figure drawn freely from the data reported by Guerrero-Orriach et al. [79]