Abstract

MAGLIOLA, Ricardo et al. Levosimendan, a new inotropic drug: experience in children with acute heart failure. Arch. argent. pediatr. [online]. 2009, vol.107, n.2, pp.139-145. ISSN 0325-0075.

Introduction. Low cardiac output syndrome occurs frequently in pediatric patients after cardiac surgery. Catecholamines are used as inotropic drugs to treat this threatening condition, but may cause undesirable and potentially harmfull side effects. This study was performed to evaluate the efficacy and safety of levosimendan (LEVO) in pediatric patients with low cardiac output syndrome. Patients and methods. Open prospective, cuasi experimental, cohort. LEVO was given as compassionate treatment in patients with refractory possurgical low cardiac output syndrome. Every patient received an IV infusion of LEVO at 6 μg/kg during a fifteen minutes period, followed by a 24 h IV infusion at 0.1 μg/kg/min. Clinical improvement of cardiac output was the primary end point of the study. Two independent observers performed clinical evaluation, bidimensional echocardiogram, hemodinamic and laboratory tests were performed pre and after LEVO infusión. Results. LEVO was infused in 18 oportunities (fourteen children). The response was considered successful in 9/18 interventions (50%; p= 0.004). Both inotropic score (12.1 vs. 6,1, p= 0.01) and A-VDO₂2 (26.78 ± 11.5% vs. 20.81 ± 7.72%, p= 0.029) showed reduction, while SvO₂ improved (69.5 ± 11.4% vs. 76 ± 9.29%, p= 0.03). No adverse effects were noticed. Four patients died, none of them related to LEVO administration. Conclusions. LEVO improved cardiac output in 50% of the interventions with pos-surgical LCOS and no adverse effect was observed.

Keywords : Low cardiac output; Levosimendan; Congenital heart disease; Pediatrics; Intensive care.

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