Evidence map›Paper›PMID 40809383›Full record

ArticleFrontiers in pediatrics2025

Pharmacokinetics of levosimendan in critically Ill children on extracorporeal membrane oxygenation: a prospective observational study.

Stéphane Bertin, David Haefliger, Maria-Helena Perez, Monia Guidi, Laurent A Decosterd, Vivianne Chanez, Ermindo R Di Paolo, Thierry Buclin, Françoise Livio

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Article in Frontiers in pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Stéphane Bertin *Service of Clinical Pharmacology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
David Haefliger *Service of Clinical Pharmacology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Maria-Helena PerezPediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Monia GuidiService of Clinical Pharmacology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Laurent A DecosterdService of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Vivianne ChanezPediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Ermindo R Di PaoloPharmacy Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Thierry BuclinService of Clinical Pharmacology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Françoise LivioService of Clinical Pharmacology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Levosimendan is used off-label in pediatrics and pharmacokinetic (PK) data in this population are scarce. The only study in critically ill patients on extracorporeal membrane oxygenation (ECMO) showed altered PK parameters. Our study aimed to characterize the PK profile of levosimendan and its metabolites in critically ill children on ECMO and assess the adequacy of current dosing practices. Methods: We conducted a prospective observational PK study in a Swiss tertiary pediatric intensive care unit. Children on ECMO for hemodynamic failure receiving continuous levosimendan infusion (0.1 µg/kg/min for 48 h) were included. Results: Five full-term newborns and one infant were included (median age 24 days). A total of seven sets of eight blood samples were collected. Median (range) steady-state levosimendan concentration was 16.68 (7.92-18.88) ng/ml. Non-compartmental analysis revealed a median clearance (CL) of 5.99 (5.18-11.32) ml/min/kg, volume of distribution (Vd) of 1.48 (1.07-6.27) L/kg, and elimination half-life of 4.59 (3.40-6.50) hours. ECMO and body composition of our patients, mostly post-cardiac surgery neonates, might explain the increased CL and Vd in our population compared to older children not on ECMO (CL 3.60 ml/min/kg, Vd 0.35 L/kg). Active metabolite OR-1896 concentrations were markedly lower than in neonates not on ECMO. Conclusions: In our cohort of critically ill children on ECMO, augmented CL and Vd were associated with low levosimendan concentrations. This suggests that dosage should be increased in this context, to achieve optimal exposure of levosimendan and its active metabolite.

Indexed as

extracorporeal membrane oxygenationinfantlevosimendanpediatricspharmacokinetics

Identifiers

PMID40809383
PMCPMC12343485

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