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Role of levosimendan in sepsis and septic shock

Pinto, Bernardo Bollena,b; Rehberg, Sebastiana; Ertmer, Christiana; Westphal, Martina

Current Opinion in Anesthesiology: April 2008 - Volume 21 - Issue 2 - p 168–177
doi: 10.1097/ACO.0b013e3282f43c56
Intensive care: Edited by Martin Westphal

Purpose of review To present the pharmacologic and biologic profile of levosimendan and discuss potential indications in the treatment of sepsis and septic shock, with a special focus on myocardial and pulmonary dysfunction.

Recent findings In animal models of endotoxic shock, levosimendan improved both left ventricular systolic and diastolic dysfunction, as well as ventriculovascular coupling. In addition, positive effects have been reported on right ventricular performance and pulmonary circulation. Two randomized, controlled trials in patients with septic shock revealed levosimendan provided consistent beneficial effects on cardiopulmonary performance, global oxygen transport, splanchnic perfusion and renal function. These effects have been reported as superior to placebo and the classic inotropic agent dobutamine. Due to its vasodilatory effects, combination with vasoconstrictor agents may be crucial in the presence of arterial hypotension.

Summary There is increasing evidence that levosimendan exerts beneficial effects in the treatment of sepsis-induced myocardial and pulmonary dysfunction. Future large-scale multicenter clinical trials are now needed to clarify whether levosimendan improves the overall outcome of patients with sepsis and septic shock.

aDepartment of Anesthesiology and Intensive Care, University Hospital of Muenster, Muenster, Germany

bDepartment of Anesthesiology, Critical Care and Emergency, Hospital Geral de Santo António, Porto, Portugal

Correspondence to Bernardo Bollen Pinto, MD, Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany Tel: +49 251 8347255; fax: +49 251 8348667; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.