Effects of levosimendan on weaning from mechanical ventilation: A systematic review and meta-analysis

There remains ongoing controversy and debate regarding the effect of levosimendan on weaning from mechanical ventilation in critical ill patients relying on ventilator. The objective of this study is to assess the specific effect of levosimendan on weaning from mechanical ventilation and to ascertain whether levosimendan can indeed improve the prognosis.

This meta-analysis was proactively registered on PROSPERO platform. The PubMed, Web of Science, Embase, ScienceDirect and Cochrane were searched from inception to June 2024. The primary outcome of interest was duration of mechanical ventilation. Secondary outcomes included mortality rates, as well as length of stay in both intensive care unit (ICU) and the hospital.

Six studies (n = 1069 patients) were included in the analysis ultimately. In relation to the primary outcome, the findings revealed that patients who received levosimendan experienced a significantly earlier successful weaning from mechanical ventilation compared to those who did not receive the medication [Mean Difference (MD) = -1.86 (95 %CI, -2.71 to -1.01, P < 0.01]. For the secondary outcomes, levosimendan was associated with a notable in both length of ICU stay [MD = -36.89 (95 %CI, -70.68 to -3.11, P < 0.01] and the total in-hospital stay [MD = -51.77 (95 %CI, -92.34 to -11.20, P < 0.01]. Levosimendan did not demonstrate a statistically effect in reducing mortality rates [Relative Risk(RR) =0.65 (95 %CI, 0.27 to 1.57, P = 0.40].

Levosimendan helps patients weaning from mechanical ventilation occuring earlier and reduces length of stay (ICU and hospital), but does not affect mortality.