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Single-center experience with levosimendan in children undergoing cardiac surgery and in children with decompensated
1Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University, Central Hospital, P,O B, 281 Stenbäckinkatu 11, FIN-00029 HUCS Helsinki, Finland. pertti.suominen@hus.fi.
Insights
Levosimendan, a drug with hemodynamic advantages, is frequently used in pediatric intensive care. Many physicians believe it reduces the need for mechanical support in children with heart conditions, though evidence is limited.
Area of Science:
- Pediatric Cardiology
- Intensive Care Medicine
- Pharmacology
Background:
- Levosimendan offers unique pharmacologic and hemodynamic benefits compared to traditional inotropic agents.
- It is primarily utilized as a rescue therapy in pediatric intensive care units (ICUs) and operating rooms.
- This study presents the most extensive single-center data on levosimendan use in pediatric patients.
Purpose of the Study:
- To analyze the clinical experience and physician perceptions of levosimendan in a pediatric intensive care setting.
- To evaluate the efficacy of levosimendan in managing pediatric cardiac conditions.
- To assess the potential of levosimendan in reducing the need for mechanical circulatory support.
Main Methods:
- A retrospective analysis of 293 children who received levosimendan infusions between 2001 and 2010.
- Data collection included patient demographics, indications for use, and treatment outcomes.
- Physician perceptions were gathered through a questionnaire assessing clinical experience with levosimendan.
Main Results:
- A total of 484 levosimendan infusions were administered, primarily to pediatric patients undergoing cardiac surgery (72%).
- Levosimendan was frequently used for cardiomyopathy (100%) and low cardiac output syndrome (94%), often when other inotropes were insufficient.
- A significant majority of physicians (89%) believed levosimendan delayed mechanical support, with 44% suggesting it was entirely avoided in some cardiac surgery patients.
Conclusions:
- Levosimendan is extensively used in this institution, with a strong physician belief in its ability to decrease mechanical support requirements.
- The drug is perceived as beneficial for children with cardiac surgery needs or decompensated heart failure.
- Further robust empirical evidence is needed to substantiate these perceived benefits in the pediatric population.
Background:
Levosimendan has pharmacologic and hemodynamic advantages over conventional intravenous inotropic agents. It has been used mainly as a rescue drug in the pediatric intensive care unit or in the operating room. We present the largest single-center experience of levosimendan in children.
Methods:
Retrospective analysis of all children who received levosimendan infusions between July 5, 2001 and July 4, 2010 in a pediatric intensive care unit. The results of a questionnaire for physicians (anesthesiologist/intensivists, cardiologists and cardiac surgeons) concerning their clinical perceptions of levosimendan are evaluated
Results:
During the study period a total of 484 infusions were delivered to 293 patients 53% of whom were male. The median age of the patients was 0.4 years (4 hours-21.1 years) at the time of levosimendan administration. A majority of levosimendan infusions were administered to children who were undergoing cardiac surgery (72%), 14% to children with cardiomyopathy and 14% to children with cardiac failure. Eighty-nine out of the 293 patients (30.4%) received repeated doses of levosimendan (up to 11 infusions). The most common indication for the use of levosimendan (94%) was when the other inotropic agents were insufficient to maintain stable hemodynamics. Levosimendan was especially used in children with cardiomyopathy (100%) or with low cardiac output syndrome (94%). A majority (89%) of the respondents believed that levosimendan administration postponed the need for mechanical assist devices in some children with cardiomyopathy. Moreover, 44% of respondents thought that the mechanical support was totally avoided in some patients undergoing cardiac surgery after receiving levosimendan.
Conclusion:
Levosimendan is widely used in our institution and many physicians believe that its use could decrease the need for mechanical support in children undergoing cardiac surgery or in children with decompensated heart failure. However, there is a lack of good empirical evidence in children to support this perception.
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