Original Articles
The Calcium Sensitizer Levosimendan Gives Superior Results to Dobutamine in Postoperative Low Cardiac Output Syndrome

https://doi.org/10.1016/S1885-5857(08)60160-7Get rights and content

Introduction and objectives

The use of levosimendan to treat postoperative low cardiac output syndrome (LCOS) has been studied in only small patient series and in randomized trials focusing on hemodynamic variables. The objective of the present study was to assess the effectiveness of levosimendan, compared with dobutamine, as a treatment for postoperative LCOS.

Methods

Patients with LCOS were randomly assigned to receive either levosimendan (loading dose, 10 μg/kg, followed by 0.1 μg/kg per min for 24 h) or dobutamine (starting dose, 5 μg/kg per min). Hemodynamic and clinical parameters (including postoperative mortality and major complications), the need for the coadministration of another drug (such as an inotrope or a vasopressor) or for balloon counterpulsation, and length of stay in intensive care were all monitored.

Results

The study included 137 patients: 69 received levosimendan, while 68 were treated with dobutamine. Although both agents improved hemodynamic parameters, the effect of levosimendan was greater and occurred earlier than that of dobutamine. In addition, levosimendan use resulted in lower postoperative mortality (8.7% vs 25%; P<.05), a lower incidence of major postoperative complications, and less need for an additional inotropic drug (8.7% vs 36.8%; P<.05), a vasopressor (11.6% vs 30.9%; P<.05), or balloon counterpulsation (2.9% vs 14.7%; P<0.05). The length of stay in intensive care was also less (66 vs 158 h; P<.05).

Conclusions

In this randomized study, levosimendan proved more effective than dobutamine. Postoperative morbidity and mortality were lower, fewer patients required either an additional inotropic drug, a vasopressor or intra-aortic balloon counterpulsation, and the length of stay in intensive care was shorter.

Introducción y objetivos

La consideración del levosimendán como tratamiento del síndrome de bajo gasto cardiaco (SBGC) postoperatorio se limita a series pequeñas o estudios aleatorizados sobre variables hemodinámicas. El objetivo del presente es evaluar, en una comparación con la dobutamina, la efectividad del levosimendán como tratamiento del SBGC postoperatorio.

Métodos

Se aleatorizó a los pacientes con SBGC a levosimendán (10 μg/kg en 1 h, seguido de 0,1 μg/kg/min por 24 h) o dobutamina (dosis inicial, 5 μg/kg/min). Se consideraron variables hemodinámicas y clínicas (mortalidad y complicaciones postoperatorias), necesidad de agregar otros fármacos (inotrópicos o vasopresores) o balón de contrapulsación, y tiempos de estancia en área intensiva.

Resultados

De los 137 pacientes incluidos, 69 recibieron levosimendán y 68, dobutamina. Ambos fármacos optimizaron variables hemodinámicas, si bien el efecto del levosimendán resultó superior y más precoz que dobutamina, además de reducir la mortalidad (el 8,7 frente al 25%; p < 0,05), las principales complicaciones postoperatorias y los requerimientos de un segundo inotrópico (el 8,7 frente al 36,8%; p < 0,05), vasopresor (el 11,6 frente al 30,9%; p < 0,05) y balón de contrapulsación (el 2,9 frente al 14,7%; p < 0,05). Asimismo, el tiempo de estancia en área de críticos resultó menor (66 frente a 158 h; p < 0,05).

Conclusiones

En una comparación aleatorizada con dobutamina, el levosimendán resultó superior, con reducción de la morbimortalidad postoperatoria, menor necesidad de agregar inotrópicos, vasopresores o balón y menos tiempo de estancia en área de cuidados intensivos.

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