Department of Medicine, Critical Care Resident, Universidad de La Sabana, Chía Cundinamarca, Colombia.
Department of Critical Care Medicine, Fundación Clínica Shaio, Bogotá, Colombia.
J Cardiovasc Pharmacol Ther. 2024 Jan-Dec;29:10742484241276431. doi: 10.1177/10742484241276431.
Acute heart failure, advanced cardiac failure, cardiac surgery, and sepsis are conditions that require simultaneous treatment to stimulate contractility and/or reduce systemic vascular resistance, with levosimendan and milrinone being treatment options. This research's aim is to review the current indications and evidence for these medications across various scenarios. Evidence suggests that levosimendan is a non-inferior alternative to dobutamine and superior to milrinone in treating low cardiac output syndrome following cardiac surgery. In cases of septic shock, levosimendan has been linked to lower mortality rates compared to placebo, while milrinone's efficacy remains inconclusive. Furthermore, postoperative patients undergoing correction for congenital heart disease have shown reduced mechanical ventilation time and intensive care unit stays when treated with levosimendan, although differences exist between the populations assigned to each intervention. In conclusion, levosimendan, compared to milrinone, appears to offer better hemodynamic favorability in patients undergoing cardiac surgery. However, additional research is necessary to further understand its impact on hemodynamic outcomes, mortality, intensive care unit, and hospital stays in patients with cardiogenic shock of both ischemic and non-ischemic etiologies, as well as septic shock.
急性心力衰竭、晚期心力衰竭、心脏手术和败血症是需要同时治疗以刺激收缩力和/或降低全身血管阻力的病症，左西孟旦和米力农是治疗选择。本研究旨在综述这些药物在各种情况下的现有适应证和证据。有证据表明，左西孟旦是多巴酚丁胺的非劣效替代药物，在心脏手术后治疗低心输出综合征方面优于米力农。在感染性休克的情况下，与安慰剂相比，左西孟旦与较低的死亡率相关，而米力农的疗效仍不确定。此外，在接受先天性心脏病矫正手术的术后患者中，与米力农相比，左西孟旦治疗可减少机械通气时间和重症监护病房的停留时间，但每个干预组的人群之间存在差异。总之，与米力农相比，左西孟旦似乎在接受心脏手术的患者中提供更好的血液动力学优势。然而，需要进一步的研究来进一步了解其对血液动力学结局、死亡率、重症监护病房和住院时间的影响，无论是缺血性和非缺血性病因引起的心源性休克还是感染性休克。
