Background: Levosimendan has pharmacologic and hemodynamic advantages over conventional intravenous\r\ninotropic agents. It has been used mainly as a rescue drug in the pediatric intensive care unit or in the operating\r\nroom. We present the largest single-center experience of levosimendan in children.\r\nMethods: Retrospective analysis of all children who received levosimendan infusions between July 5, 2001 and\r\nJuly 4, 2010 in a pediatric intensive care unit. The results of a questionnaire for physicians (anesthesiologist/\r\nintensivists, cardiologists and cardiac surgeons) concerning their clinical perceptions of levosimendan are evaluated\r\nResults: During the study period a total of 484 infusions were delivered to 293 patients 53% of whom were male.\r\nThe median age of the patients was 0.4 years (4 hours-21.1 years) at the time of levosimendan administration.\r\nA majority of levosimendan infusions were administered to children who were undergoing cardiac surgery (72%),\r\n14% to children with cardiomyopathy and 14% to children with cardiac failure. Eighty-nine out of the 293 patients\r\n(30.4%) received repeated doses of levosimendan (up to 11 infusions). The most common indication for the use of\r\nlevosimendan (94%) was when the other inotropic agents were insufficient to maintain stable hemodynamics.\r\nLevosimendan was especially used in children with cardiomyopathy (100%) or with low cardiac output syndrome\r\n(94%). A majority (89%) of the respondents believed that levosimendan administration postponed the need for\r\nmechanical assist devices in some children with cardiomyopathy. Moreover, 44% of respondents thought that the\r\nmechanical support was totally avoided in some patients undergoing cardiac surgery after receiving levosimendan.\r\nConclusion: Levosimendan is widely used in our institution and many physicians believe that its use could decrease\r\nthe need for mechanical support in children undergoing cardiac surgery or in children with decompensated heart\r\nfailure. However, there is a lack of good empirical evidence in children to support this perception.
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