Does levosimendan improve weaning outcome? It does much more

levosimendan was introduced into clini cal practice about twenty years ago for the treatment of heart failure. levosimendan imme diately proved to be an excellent drug with an innovative and highly physiological mechanism of action. on the one hand, its inotropic action is achieved with a mechanism different from that of catecholaminergic drugs and phosphodiesterase inhibitors, on the other, a marked peripheral va sodilating action favors the reduction of afterload and therefore improves peripheral perfusion.1 From the first experimental studies, there was a marked activity on the KatP channel favorable to the modulation of the intracellular and intra mitochondrial calcium input capable of justify ing a cardiac and extracardiac protective effect.2