Comparative study of two ionotropes, levosimendan and dobutamine, in critically ill patients suffering from heart failure

Abstract

Objective: Acute heart failure frequently happens in critically ill patients due to myocardial injury, cardiac dysfunction, arrhythmias, and inflammatory mediators. Till now, the outcomes of studies comparing levosimendan with dobutamine for patients requiring inotropic support remain controversial and ambiguous.  The present study was aimed to compare the effects of levosimendan and dobutamine in the management of critically ill patients in ICU and establish preference of one over the other drug.
Methodology: In this study 100 critically ill patients with clinical diagnosis of heart failure or impending heart failure due to any cause of age between 21 years to 80 years (left ventricular ejection fraction < 35%) in ICU were included and randomly divided into 2 groups; Group-1 (n=50) received inj levosimendan and Group-2 (n=50) which received inj dobutamine. The parameters recorded during study were: heart rate (beats/min),
systolic blood pressure (mmHg), stroke volume (ml), cardiac output (l/min), cardiac index (l/min/m²), brain natriuretic peptide (pg/ml), requirement of ionotropic agent and 7 day survival. Baseline parameters of the patient at “0” h was recorded, then the ionotrope (levosimendan or dobutamine) was started. After this the parameters were recorded at 24 h, 48 h and 5th day of study and follow-up of patient was done upto 7 days. SPSS for Windows version 16.0 software was used for statistical analysis. For non-continuous data Chi-square test was used. The mean and standard deviation of the parameters compared using student “t” test. The p < 0.05 was considered as significant.
Results: The distribution of patients according to age, sex and body surface area was comparable (p > 0.05) in both the groups. Heart rate decreased significantly in both the groups at 24 h and 5th day, although it remained higher in Group-1 patients receiving levosimendan. Systolic blood pressure and Cardiac Index (CI) increased significantly in both the groups but was more in Group-1 patients receiving levosimendan at all times. Cardiac output increased significantly in Group-1 pts whereas in Group-2, after an initial increase for first 48 hrs ultimately decrease in cardiac output was observed on 5th day. 7 Day survival was more (56%) in Group-1 patients as compared to 52% in Group-2 patients.
Conclusion: Based upon the results of our study, we conclude that levosimendan shows better results than dobutamine in maintaining hemodynamic stability in critically ill patients. Larger, multi-center studies may have to be done for confirming or discrediting our results.
Citation: Jain D, Loha S, Chandrakar D, Debburma M, Singh DK. Comparative study of two ionotropes, levosimendan and dobutamine, in critically ill patients suffering from heart failure Anaesth Pain & Intensive Care 2018;22(4):­­456-462
Received: 24 Oct 2018, Reviewed: 02 Dec, 28 Dec 2018, Corrected: 01 Nov 2018, Accepted: 28 Dec 2018