Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis
Introducción: Los pacientes llevados a cirugía cardiaca tienen riesgo de desarrollar síndrome de bajo gasto cardiaco posoper- atorio (SBGC). Estudios previos han encontrado una menor mortalidad con levosimendán respecto a placebo u otros inotrópicos; sin embargo, tres experimentos clínicos no encon-...
- Autores:
-
Oliveros, Henry
Rubio, Cristhian
Garcia, Hans
Navarrete, Javier
- Tipo de recurso:
- Fecha de publicación:
- 2018
- Institución:
- Universidad Militar Nueva Granada
- Repositorio:
- Repositorio UMNG
- Idioma:
- spa
- OAI Identifier:
- oai:repository.unimilitar.edu.co:10654/35117
- Acceso en línea:
- http://hdl.handle.net/10654/35117
- Palabra clave:
- Cardiac surgery
Low cardiac output syndrome
Inotropes
Levosimendan
CARDIOLOGIA
INSUFICIENCIA CARDIACA
ENFERMEDADES CARDIACAS
CORAZON-CIRUGIA
cirugia cardiaca
Síndrome de bajo gasto cardiaco posoperatorio
Inotrópicos
Levosimendán
- Rights
- License
- Derechos Reservados - Universidad Militar Nueva Granada, 2020
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| dc.title.spa.fl_str_mv |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| dc.title.translated.spa.fl_str_mv |
Perioperative use of levosimendan in patients undergoing cardiac surgery: systematic review and meta-analysis |
| title |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| spellingShingle |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis Cardiac surgery Low cardiac output syndrome Inotropes Levosimendan CARDIOLOGIA INSUFICIENCIA CARDIACA ENFERMEDADES CARDIACAS CORAZON-CIRUGIA cirugia cardiaca Síndrome de bajo gasto cardiaco posoperatorio Inotrópicos Levosimendán |
| title_short |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| title_full |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| title_fullStr |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| title_full_unstemmed |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| title_sort |
Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis |
| dc.creator.fl_str_mv |
Oliveros, Henry Rubio, Cristhian Garcia, Hans Navarrete, Javier |
| dc.contributor.advisor.spa.fl_str_mv |
Oliveros, Henry |
| dc.contributor.author.spa.fl_str_mv |
Oliveros, Henry Rubio, Cristhian Garcia, Hans Navarrete, Javier |
| dc.subject.keywords.spa.fl_str_mv |
Cardiac surgery Low cardiac output syndrome Inotropes Levosimendan |
| topic |
Cardiac surgery Low cardiac output syndrome Inotropes Levosimendan CARDIOLOGIA INSUFICIENCIA CARDIACA ENFERMEDADES CARDIACAS CORAZON-CIRUGIA cirugia cardiaca Síndrome de bajo gasto cardiaco posoperatorio Inotrópicos Levosimendán |
| dc.subject.decs.none.fl_str_mv |
CARDIOLOGIA INSUFICIENCIA CARDIACA ENFERMEDADES CARDIACAS CORAZON-CIRUGIA |
| dc.subject.proposal.spa.fl_str_mv |
cirugia cardiaca Síndrome de bajo gasto cardiaco posoperatorio Inotrópicos Levosimendán |
| description |
Introducción: Los pacientes llevados a cirugía cardiaca tienen riesgo de desarrollar síndrome de bajo gasto cardiaco posoper- atorio (SBGC). Estudios previos han encontrado una menor mortalidad con levosimendán respecto a placebo u otros inotrópicos; sin embargo, tres experimentos clínicos no encon- traron beneficio frente a este desenlace. Objetivo: Evaluar la evidencia del levosimendán sobre la mortalidad y los desenlaces secundarios en pacientes sometidos a cirugía cardiaca, y determinar las fuentes de heterogeneidad. Métodos: Mediante una revisión sistemática y metaanálisis de los experimentos clínicos que evaluaron la eficacia del levosi- mendán en los pacientes llevados a cirugía cardiaca, se evaluó la eficacia en la mortalidad y en otros desenlaces, como lesión renal y SBGC, utilizando los modelos de efectos fijos y aleatorios. Resultados: De 47 estudios identificados, fueron seleccionados 14 (n = 2752). Respecto al desenlace de mortalidad y el uso de levosimendán solo se encontró una disminución en los estudios de baja calidad (OR 0.30; IC 95%, 0.18–0.51), mientras que para los de alta calidad no hubo efecto protector (OR 0.99; IC 95%, 0.70–1.40) con un I2 = 0%. La calidad de los estudios y la fracción de eyección fueron las principales fuentes de heterogeneidad. Conclusión: el uso del levosimendán en los pacientes llevados a cirugía cardiovascular no tiene efectos sobre la mortalidad a 30 días en los estudios de alta calidad. Hubo efecto protector sobre la falla renal postoperatoria con necesidad de diálisis. |
| publishDate |
2018 |
| dc.date.issued.none.fl_str_mv |
2018-11-18 |
| dc.date.accessioned.none.fl_str_mv |
2020-03-17T16:35:53Z |
| dc.date.available.none.fl_str_mv |
2020-03-17T16:35:53Z |
| dc.type.spa.fl_str_mv |
info:eu-repo/semantics/bachelorThesis |
| dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_7a1f |
| dc.type.local.spa.fl_str_mv |
Trabajo de grado |
| dc.type.dcmi-type-vocabulary.spa.fl_str_mv |
Text |
| dc.identifier.uri.none.fl_str_mv |
http://hdl.handle.net/10654/35117 |
| url |
http://hdl.handle.net/10654/35117 |
| dc.language.iso.spa.fl_str_mv |
spa spa |
| language |
spa |
| dc.relation.references.spa.fl_str_mv |
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics—2016 Update [Internet]. Vol. 133, Circulation. 2016. 38-360 p. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350 Mehta R, Grab J, O’Brien S. Clinical Characteristics and In-Hospital Outcomes of Patients With Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery Insights From the Society of. Circulation. 2008;876–85. Algarni KD, Maganti M, Yau TM. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: Trends over 20 years. Ann Thorac Surg. 2011;92(5):1678–84. Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A. Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome. Anesthesiology. 2008;108(6):979–87. Zangrillo A, Biondi-Zoccai G, Ponschab M, Greco M, Corno L, Covello RD, et al. Milrinone and mortality in adult cardiac surgery: A meta-analysis. J Cardiothorac Vasc Anesth. 2012;26(1):70–7. Nielsen DV, Torp-Pedersen C, Skals RK, Gerds TA, Karaliunaite Z, Jakobsen CJ. Intraoperative milrinone versus dobutamine in cardiac surgery patients: A 12 retrospective cohort study on mortality. Crit Care. 2018;22(1):1–11. Pilarczyk K, Boening A, Jakob H, Langebartels G, Markewitz A, Haake N, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials. Eur J Cardio-thoracic Surg. 2016;49(1):5–17. Deppe AC, Weber C, Liakopoulos OJ, Zeriouh M, Slottosch I, Scherner M, et al. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality—A meta- analysis of 9,212 patients. J Card Surg. 2017;32(3):177–85. Gaudard P, Mourad M, Eliet J, Zeroual N, Culas G, Rouvière P, et al. Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock. Crit Care [Internet]. 2015;19(1):1–12. Available from: http://dx.doi.org/10.1186/s13054-015-1073-8 Griffith BP, Anderson MB, Samuels LE, Pae WE, Naka Y, Frazier OH. The RECOVER I: A multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support. J Thorac Cardiovasc Surg [Internet]. 2013;145(2):548–54. Available from: http://dx.doi.org/10.1016/j.jtcvs.2012.01.067 Burkhoff D, Cohen H, Brunckhorst C, O’Neill WW. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006;152(3). Arbor A. ECLS Registry Report Survived to DC or. 2017;2017(c):1–34. Papp Z, Édes I, Fruhwald S, De Hert SG, Salmenperä M, Leppikangas H, et al. Levosimendan: molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan. Int J Cardiol. 2012 Aug;159(2):82–7. McBride BF, White CM. Levosimendan: Implications for clinicians. J Clin Pharmacol. 2003;43(10):1071–81. Faisal SA, Apatov DA, Ramakrishna H, Weiner MM. Levosimendan in Cardiac Surgery: Evaluating the Evidence. J Cardiothorac Vasc Anesth. 2018;000. Harrison RW, Hasselblad V, Mehta RH, Levin R, Harrington RA, Alexander JH. 13 Effect of levosimendan on survival and adverse events after cardiac surgery: A meta- analysis. J Cardiothorac Vasc Anesth. 2013;27(6):1224–32. Mehta RH, Leimberger JD, van Diepen S, Meza J, Wang A, Jankowich R, et al. Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery. N Engl J Med. 2017;376(21):2032–42. Landoni G, Lomivorotov V V., Alvaro G, Lobreglio R, Pisano A, Guarracino F, et al. Levosimendan for Hemodynamic Support after Cardiac Surgery. N Engl J Med. 2017;376(21):2021–31. Cholley B, Caruba T, Grosjean S, Amour J, Ouattara A, Villacorta J, et al. Effect of levosimendan on low cardiac output syndrome in patients with low ejection fraction undergoing coronary artery bypass grafting with cardiopulmonary bypass - The LICORN randomized clinical trial. JAMA - J Am Med Assoc. 2017;318(6):548–56. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34. Cochrane C. Centro Cochrane Iberoamericano, traductores. Manual Cochrane de Revisiones Sistemáticas de Intervenciones, versión 5.1.0. 2011;(March):1–639. Available from: https://es.cochrane.org/sites/es.cochrane.org/files/public/uploads/Manual_Cochrane_ 510_reduit.pdf Baysal A, Yanartas M, Dogukan M, Gundogus N, Kocak T, Koksal C. Levosimendan improves renal outcome in cardiac surgery: A randomized trial. J Cardiothorac Vasc Anesth. 2014;28(3):586–94. Erb J, Beutlhauser T, Feldheiser A, Schuster B, Treskatsch S, Grubitzsch H, et al. Influence of levosimendan on organ dysfunction in patients with severely reduced left ventricular function undergoing cardiac surgery. J Int Med Res. 2014;42(3):750– 64. Sharma P, Malhotra A, Gandhi S, Garg P, Bishnoi A, Gandhi H. Preoperative levosimendan in ischemic mitral valve repair. Asian Cardiovasc Thorac Ann. 2014 Jun;22(5):539–45. Shastri N, Patel J, Malhotra A, Shah B, Sharma P, Brahmbhatt A, et al. Study of levosimendan during off-pump coronary artery bypass grafting in patients with LV dysfunction: A double-blind randomized study. Indian J Pharmacol [Internet]. 2014;46(1):29. Available from: http://www.ijp- online.com/text.asp?2014/46/1/29/125161 Al-Shawaf E, Ayed A, Vislocky I, Radomir B, Dehrab N, Tarazi R. Levosimendan or milrinone in the type 2 diabetic patient with low ejection fraction undergoing elective coronary artery surgery. J Cardiothorac Vasc Anesth. 2006 Jun;20(3):353–7. De Hert SG, Lorsomradee S, Cromheecke S, Van der Linden PJ. The effects of levosimendan in cardiac surgery patients with poor left ventricular function. Anesth Analg. 2007 Apr;104(4):766–73. Levin RL, Degrange MA, Porcile R, Salvagio F, Blanco N, Botbol AL, et al. [The calcium sensitizer levosimendan gives superior results to dobutamine in postoperative low cardiac output syndrome]. Rev Esp Cardiol. 2008 May;61(5):471– 9. Eriksson HI, Jalonen JR, Heikkinen LO, Kivikko M, Laine M, Leino KA, et al. Levosimendan facilitates weaning from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting with impaired left ventricular function. Ann Thorac Surg. 2009 Feb;87(2):448–54. Tritapepe L, De Santis V, Vitale D, Guarracino F, Pellegrini F, Pietropaoli P, et al. Levosimendan pre-treatment improves outcomes in patients undergoing coronary artery bypass graft surgery. Br J Anaesth. 2009;102(2):198–204. Lahtinen P, Pitkänen O, Pölönen P, Turpeinen A, Kiviniemi V, Uusaro A. Levosimendan reduces heart failure after cardiac surgery: A prospective, randomized, placebo-controlled trial. Crit Care Med. 2011;39(10):2263–70. Levin R, Degrange M, Del Mazo C, Tanus E, Porcile R. Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass. Exp Clin Cardiol. 2012 Sep;17(3):125–30. Lomivorotov V V., Efremov SM, Kirov MY, Fominskiy E V., Karaskov AM. Low- Cardiac-Output Syndrome After Cardiac Surgery. J Cardiothorac Vasc Anesth. 15 2017;31(1):291–308. Maharaj R, Metaxa V. Levosimendan and mortality after coronary revascularisation: A meta-analysis of randomised controlled trials. Crit Care [Internet]. 2011;15(3):R140. Available from: http://ccforum.com/content/15/3/R140 Lim JY, Deo S V., Rababa’H A, Altarabsheh SE, Cho YH, Hang D, et al. Levosimendan Reduces Mortality in Adults with Left Ventricular Dysfunction Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis. J Card Surg. 2015;30(7):547–54. Elbadawi A, Elgendy IY, Saad M, Megaly M, Mentias A, Abuzaid AS, et al. Meta- Analysis of Trials on Prophylactic Use of Levosimendan in Patients Undergoing Cardiac Surgery. Ann Thorac Surg [Internet]. 2018;105(5):1403–10. Available from: https://doi.org/10.1016/j.athoracsur.2017.11.027 Guarracino F, Heringlake M, Cholley B, Bettex D, Bouchez S, Lomivorotov V V., et al. Use of levosimendan in cardiac surgery: An update after the LEVO-CTS, CHEETAH, and LICORN trials in the light of clinical practice. J Cardiovasc Pharmacol. 2018;71(1):1–9. Sanfilippo F, Knight JB, Scolletta S, Santonocito C, Pastore F, Lorini FL, et al. Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: A systematic review and meta-analysis. Crit Care. 2017;21(1):1–10. Glasziou PP, Sanders SL. Investigating causes of heterogeneity in systematic reviews. Stat Med. 2002;21(11):1503–11. Zhou C, Gong J, Chen D, Wang W, Liu M, Liu B. Levosimendan for prevention of acute kidney injury after cardiac surgery: A meta-analysis of randomized controlled trials. Am J Kidney Dis [Internet]. 2016;67(3):408–16. Available from: http://dx.doi.org/10.1053/j.ajkd.2015.09.015 García-González MJ, Jorge-Pérez P, Jiménez-Sosa A, Acea AB, Lacalzada Almeida JB, Ferrer Hita JJ. Levosimendan Improves Hemodynamic Status in Critically Ill Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction: An Interventional Study. Cardiovasc Ther. 2015;33(4):193–9. Yilmaz MB, Grossini E, Silva Cardoso JC, Édes I, Fedele F, Pollesello P, et al. 16 Renal effects of levosimendan: A consensus report. Cardiovasc Drugs Ther. 2013;27(6):581–90. Alvarez J, Bouzada M, Fernández AL, Caruezo V, Taboada M, Rodríguez J, et al. [Hemodynamic effects of levosimendan compared with dobutamine in patients with low cardiac output after cardiac surgery]. Rev española Cardiol [Internet]. 2006;59(4):338–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16709386 Leppikangas H, Jrvelä K, Sisto T, Maaranen P, Virtanen M, Lehto P, et al. Preoperative levosimendan infusion in combined aortic valve and coronary bypass surgery. Br J Anaesth. 2011;106(3):298–304. |
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Derechos Reservados - Universidad Militar Nueva Granada, 2020 |
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http://purl.org/coar/access_right/c_abf2 |
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Atribución-NoComercial-SinDerivadas |
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Derechos Reservados - Universidad Militar Nueva Granada, 2020 https://creativecommons.org/licenses/by-nc-nd/2.5/co/ Atribución-NoComercial-SinDerivadas http://purl.org/coar/access_right/c_abf2 |
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Universidad Militar Nueva Granada |
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Facultad de Medicina |
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Medicina crítica y cuidados intensivos |
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Medicina y Ciencias de la Salud - Medicina crítica y cuidados intensivos |
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Universidad Militar Nueva Granada |
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Oliveros, HenryOliveros, HenryRubio, CristhianGarcia, HansNavarrete, JavierEspecialista en Medicina crítica y cuidados intensivosMedicina2020-03-17T16:35:53Z2020-03-17T16:35:53Z2018-11-18http://hdl.handle.net/10654/35117Introducción: Los pacientes llevados a cirugía cardiaca tienen riesgo de desarrollar síndrome de bajo gasto cardiaco posoper- atorio (SBGC). Estudios previos han encontrado una menor mortalidad con levosimendán respecto a placebo u otros inotrópicos; sin embargo, tres experimentos clínicos no encon- traron beneficio frente a este desenlace. Objetivo: Evaluar la evidencia del levosimendán sobre la mortalidad y los desenlaces secundarios en pacientes sometidos a cirugía cardiaca, y determinar las fuentes de heterogeneidad. Métodos: Mediante una revisión sistemática y metaanálisis de los experimentos clínicos que evaluaron la eficacia del levosi- mendán en los pacientes llevados a cirugía cardiaca, se evaluó la eficacia en la mortalidad y en otros desenlaces, como lesión renal y SBGC, utilizando los modelos de efectos fijos y aleatorios. Resultados: De 47 estudios identificados, fueron seleccionados 14 (n = 2752). Respecto al desenlace de mortalidad y el uso de levosimendán solo se encontró una disminución en los estudios de baja calidad (OR 0.30; IC 95%, 0.18–0.51), mientras que para los de alta calidad no hubo efecto protector (OR 0.99; IC 95%, 0.70–1.40) con un I2 = 0%. La calidad de los estudios y la fracción de eyección fueron las principales fuentes de heterogeneidad. Conclusión: el uso del levosimendán en los pacientes llevados a cirugía cardiovascular no tiene efectos sobre la mortalidad a 30 días en los estudios de alta calidad. Hubo efecto protector sobre la falla renal postoperatoria con necesidad de diálisis.Tabla de contenido 1. RESUMEN ESTRUCTURADO .................................................................................. 4 2. IDENTIFICACIÓN Y FORMULACIÓN DEL PROBLEMA................................... 4 3. OBJETIVOS ................................................................................................................ 6 3.1. Objetivo general .................................................................................................... 6 3.2 Objetivos específicos............................................................................................... 6 4. METODOLOGÍA ........................................................................................................ 6 4.1 Selección de los estudios......................................................................................... 6 4.2 Criterios para incluir los estudios en esta revisión................................................ 6 4.3 Extracción de la información................................................................................. 7 4.4 Análisis estadístico.................................................................................................. 7 5. ASPECTOS ÉTICOS................................................................................................... 7 6. RESULTADOS ............................................................................................................ 7 6.1 Hallazgos generales y evaluación de la calidad de los estudios............................. 7 6.2 Mortalidad a 30 días............................................................................................... 8 6.3 Desenlaces secundarios .......................................................................................... 9 6.4 Sesgo de publicación............................................................................................... 9 7. DISCUSION ................................................................................................................. 9 8. CONCLUSION .......................................................................................................... 12 9. REFERENCIAS......................................................................................................... 12 10. TABLAS ................................................................................................................... 18 Tabla 1: Características de los estudios que incluyeron los desenlaces de mortalidad a 30 días, lesión renal aguda postoperatoria con necesidad de diálisis y fibrilación auricular postoperatoria............................................................................................ 18 11. Títulos de las figuras ................................................................................................ 19 Figura 1. Flujograma identificación y selección de los estudios. .............................. 20 Figura 2. Evaluación del riesgo de sesgo de los estudios incluidos en el metaanálisis. En rojo: alto riesgo, en verde: bajo riesgo, y casilla en blanco: no claro. ................ 21 Figura 3. Efecto del tratamiento con levosimendán vs. terapia estándar en la mortalidad a 30 días en pacientes sometidos a cirugía cardiaca. ............................. 22 Figura 4. Efecto sobre desenlaces secundarios del levosimendán vs. terapia estándar ...................................................................................................................... 23 Figura 5. Gráfico de embudo para mortalidad a 30 días.......................................... 24 12. ANEXOS .................................................................................................................. 25 3 Anexo No 1 ................................................................................................................. 25 Anexo 2. Efecto del tratamiento con levosimendán vs. terapia estándar en el desarrollo de síndrome de bajo gasto cardiaco postoperatorio................................ 27Introduction: Patients undergoing cardiac surgery frequently develop low cardiac output syndrome (LCOS). Multiple inter- ventions including levosimendan have been used in the prevention and treatment of LCOS. Preliminary studies reported lower mortality respect to placebo or other inotropes, however, recently, 3 clinical trials found no benefit against this outcome. Objective: Our objective was to evaluate the evidence of levosimendan on mortality and secondary outcomes in patients undergoing cardiac surgery, and to determine the sources of heterogeneity. Methods: We conducted a systematic review and meta- analysis of the clinical trials that evaluated the efficacy of levosimendan in patients undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality and other outcomes such as kidney injury with dialysis requirement and LCOS, using fixed and random effects models. The risk of bias was assessed and the sources of heterogeneity were explored. Results: Of 47 studies identified, 14 studies were selected (n=2752). Regarding the mortality outcome and use of levosi- mendan, only a decrease was found in the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While high-quality studies, there was no protective effect (OR 0.99, 95% CI 0.70–1.40) with an I2 = 0%. The quality of the studies and ejection fraction were the main sources of heterogeneity. Conclusion: In high-quality studies, the use of levosimendan in patients undergoing cardiovascular surgery has no effect on 30-day mortality. There was a protective effect on postoperative renal failure with dialysis.Especializaciónpdfapplication/pdfspaspaUniversidad Militar Nueva GranadaFacultad de MedicinaMedicina crítica y cuidados intensivosMedicina y Ciencias de la Salud - Medicina crítica y cuidados intensivosDerechos Reservados - Universidad Militar Nueva Granada, 2020https://creativecommons.org/licenses/by-nc-nd/2.5/co/Atribución-NoComercial-SinDerivadashttp://purl.org/coar/access_right/c_abf2Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisisPerioperative use of levosimendan in patients undergoing cardiac surgery: systematic review and meta-analysisinfo:eu-repo/semantics/bachelorThesisTrabajo de gradoTexthttp://purl.org/coar/resource_type/c_7a1fCardiac surgeryLow cardiac output syndromeInotropesLevosimendanCARDIOLOGIAINSUFICIENCIA CARDIACAENFERMEDADES CARDIACASCORAZON-CIRUGIAcirugia cardiacaSíndrome de bajo gasto cardiaco posoperatorioInotrópicosLevosimendánMozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. 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Br J Anaesth. 2011;106(3):298–304.ORIGINALManuscrito Trabajo de Grado.pdfManuscrito Trabajo de Grado.pdfArticuloapplication/pdf1144909http://repository.unimilitar.edu.co/bitstream/10654/35117/1/Manuscrito%20Trabajo%20de%20Grado.pdf81d59b54525862ffa8c14383b6e01f3fMD51Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca Español.pdfUso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca Español.pdfapplication/pdf663702http://repository.unimilitar.edu.co/bitstream/10654/35117/2/Uso%20perioperatorio%20de%20levosimend%c3%a1n%20en%20pacientes%20sometidos%20a%20cirug%c3%ada%20cardiaca%20Espa%c3%b1ol.pdf18cdb5ec3cf6c6917e8b62adc6d80ac2MD52Perioperative use of levosimendan in patients undergoing cardiac surgery systematic review and meta analysis.pdfPerioperative use of levosimendan in patients undergoing cardiac surgery systematic review and meta 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