REVIEW   Free access

Minerva Anestesiologica 2020 June;86(6):645-51

DOI: 10.23736/S0375-9393.20.14219-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Levosimendan to facilitate weaning from cardiorespiratory support in critically ill patients: current evidence and future directions

Fabio SANGALLI ^{1, 2} ✉, Giacomo BELLANI ^{2, 3}, Alessandro AFFRONTI ⁴, Francesca VOLPI ^{4, 5}, Marco FERI ⁶, Marco MARINI ⁷, Antonio QUACQUARELLI ⁸, Domenico VITALE ⁹, Fabio GUARRACINO ¹⁰

¹ ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; ² University of Milano-Bicocca, Monza, Monza-Brianza, Italy; ³ ASST Monza, San Gerardo Hospital, Monza, Monza-Brianza, Italy; ⁴ Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy; ⁵ Department of Anesthesia and Intensive Care, Santa Maria della Misericordia Hospital, Perugia, Italy; ⁶ Internsive Therapy Department Functional Area, Perioperative Medicine and Antalgic Therapy, Medicina perioperatoria e Terapia antalgica Azienda Usl Toscana sud est, Arezzo, Italy; ⁷ Department of Cardiovascular Science, Unit of Cardiology-Hemodynamics Utic, AOU Ospedali Riuniti, Ancona, Italy; ⁸ San Donato Hospital, Arezzo, Italy; ⁹ Clinical Epidemiology Service, Salvatore Maugeri Foundation, Scientific Institute of Telese, Telese Terme, Benevento, Italy; ¹⁰ Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

Appropriate weaning is of crucial importance for critically ill patients requiring respiratory support. However, a remarkable proportion of them are difficult to wean. Levosimendan is a positive inotropic agent characterized by vasodilatory properties, which is used for the treatment of acute decompensated heart failure or in patients needing inotropic treatment, including cardiogenic shock, septic shock, pulmonary hypertension and right ventricular dysfunction, needed for hemodynamic support in patients with diuretic resistance, and weaning either from ventilator or from extracorporeal membrane oxygenation. This position paper will discuss the use of levosimendan in facilitating weaning from cardiorespiratory support in critically ill patients, according to available evidence and the personal experience of a group of Italian Experts.

KEY WORDS: Ventilator weaning; Simendan; Respiration, artificial; Extracorporeal membrane oxygenation