Levosimendan is a calcium sensitizer, its enhancement of myocardial contraction is as a result of increasing the sensitivity of myocardial calcium ions and troponin C. Compared with other inotropic agents, it can improve diastolic function without increasing oxygen consumption in the myocardium. It has a vasodilator effect by opening the potassium ion channel sensitive to adenosine triphosphate (ATP) on vascular smooth muscle cells and by opening the potassium ion channel sensitive to ATP on the mitochondria of cardiomyocytes to achieve cardio protection. Levosimendan has a fast onset of action with a half-life of 1 hour, its active metabolite half-life is about 80 hours, and the action time can prolong for 7–9 days. Levosimendan has these unique pharmacological properties, and it has been not only approved for acute decompensated heart failure but also applied clinically for various severe conditions including cardiogenic shock, septic shock, pulmonary hypertension and right ventricular dysfunction, cardiorenal syndrome, and weaning from extra-corporeal membrane oxygenation. However, because the empirical evidence for these potential indications is still incomplete or the results of research trials occasionally show inconsistencies, more high-level empirical studies and further clinical evaluations are needed to verify the role of levosimendan in these potential indications. Through the literature review and analysis, this article is to explore the clinical application and treatment of levosimendan in critically ill patients.
Summited for publication: 2021.1.28; Accepted for publication: 2021.5.21