Levosimendan is an inodilator that promotes cardiac contractility primarily through calcium sensitization of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells; the drug also exerts organ-protective effects through a similar effect on mitochondrial KATP channels. This pharmacological profile identifies levosimendan as a drug that may have applications in a wide range of critical illness situations encountered in intensive care unit medicine: hemodynamic support in cardiogenic or septic shock; weaning from mechanical ventilation or from extracorporeal membrane oxygenation; and in the context of cardiorenal syndrome. This review, authored by experts from 9 European countries (Austria, Belgium, Czech republic, Finland, France, Germany, Italy, Sweden, and Switzerland), examines the clinical and experimental data for levosimendan in these situations and concludes that, in most instances, the evidence is encouraging, which is not the case with other cardioactive and vasoactive drugs routinely used in the intensive care unit. The size of the available studies is, however, limited and the data are in need of verification in larger controlled trials. Some proposals are offered for the aims and designs of these additional studies.

Critical Care Orion Pharma Espoo Finland

Department of Anaesthesia and Intensive Care Medicine San Gerardo Hospital Monza Italy

Department of Anesthesiology and Intensive Care Medicine Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Anesthesiology and Intensive Care Sahlgrenska Universitetssjukhuset Gothenburg Sweden

Department of Anesthesiology University Hospital Ghent Belgium

Department of Bone Marrow Transplantation University of Duisburg Essen Essen Germany

Department of Intensive Care Hôpital Erasme Brussels Belgium

Dipartimento di Anestesia e Terapie Intensive Azienda Ospedaliero Universitaria Pisana Pisa Italy

INSERM U 1116 Groupe Choc Equipe 2 Faculté de Médecine Vandoeuvre Les Nancy Nancy France

Institut für Anästhesiologie und Intensivmedizin 2 Klinikum Wels Grieskirchen Wels Austria

Institute of Anaesthesiology University Hospital Zürich Zürich Switzerland

Struttura Complessa di Anestesia 1 Policlinico di Modena Modena Italy

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Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use