Applications of levosimendan in paediatric intensive care

Mark G Davidson, Johnny Millar, Warwick W Butt,Lara S Shekerdemian

Paediatric Intensive Care Unit, Royal Children’s Hospital,Melbourne, VIC

Introduction

Levosimendan is a calcium-sensitising agent which has been shown to be beneficial in adult cardiac failure. There are limited reports of its use in critically ill children following cardiac surgery.

Aim

To review and describe indications for, and use of, levosimendan in a large paediatric intensive care unit.

Setting

A tertiary paediatric ICU, December 2003 to December 2005.

Observations

Since December 2003, we have used levosimendan in 55 patients, a total of 87 times, during 69 intensive care admissions. Thirty-seven patients (67%) received a single dose, and 18 patients (33%) received more than one dose. Median weight of patients was 14.9 kg (interquartile range [IQR], 5.1– 32kg), and median age was 41.6 months (IQR, 3.7–152.5 months). In-hospital mortality was 14/55 (26%), with 11 deaths in the ICU, and three deaths before hospital discharge.

Levosimendan was given:

• after surgery for congenital heart disease in 29 of the 55 patients (53%), with a total of 39 doses given;
• after heart transplantation in six (11%), with a total of eight doses given; six of these were given acutely(median, 3 days;range, 1–23 days) after transplantation; and
• to treat sepsis-induced myocardial suppression in two patients (4%).

Levosimendan was used in 19 patients during extracorporeal life support (ECLS): 13 after cardiac surgery; five in endstage heart failure; and one after cardiac transplant. It was given a mean of 5 days before decannulation. In-hospital mortality in this group was 8/17 (59%), with patients currently still in hospital.

Conclusions

We are increasingly using levosimendan to treat children in our ICU. Most of these children have low cardiac output following cardiac surgery, end-stage heart failure, or are weaning from ECLS. Randomised clinical trials are warranted to define the utility of levosimendan for each of these indications.