Skip to main content
SpringerLink
Log in

Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials

  • Published:
Journal of Zhejiang University SCIENCE B Aims and scope Submit manuscript

Abstract

Objective

To evaluate the clinical efficacy of levosimendan versus dobutamine in critically ill patients requiring inotropic support.

Methods

Clinical trials were searched in PubMed, EMBASE, and the Cochrane Central Registry of Clinical Trials, as well as Web of Science. Studies were included if they compared levosimendan with dobutamine in critically ill patients requiring inotropic support, and provided at least one outcome of interest. Outcomes of interest included mortality, incidence of hypotension, supraventricular arrhythmias, and ventricular arrhythmias.

Results

Data from a total of 3 052 patients from 22 randomized controlled trials (RCTs) were included in the analysis. Overall analysis showed that the use of levosimendan was associated with a significant reduction in mortality (269 of 1 373 [19.6%] in the levosimendan group, versus 328 of 1 278 [25.7%] in the dobutamine group, risk ratio (RR)=0.81, 95% confidence interval (CI) 0.70-0.92, P for effect=0.002). Subgroup analysis indicated that the benefit from levosimendan could be found in the subpopulations of cardiac surgery, ischemic heart failure, and concomitant β-blocker therapy in comparison with dobutamine. There was no significant difference in the incidence of hypotension, supraventricular arrhythmias, or ventricular arrhythmias between the two drugs.

Conclusions

In contrast with dobutamine, levosimendan is associated with a significant improvement in mortality in critically ill patients requiring inotropic support. Patients having cardiac surgery, with ischemic heart failure, and receiving concomitant β-blocker therapy may benefit from levosimendan. More RCTs are required to address the questions about no positive outcomes in the subpopulation in a cardiology setting, and to confirm the advantages in long-term prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abraham, W.T., Adams, K.F., Fonarow, G.C., Costanzo, M.R., Berkowitz, R.L., LeJemtel, T.H., Cheng, M.L., Wynne, J., 2005. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J. Am. Coll. Cardiol., 46(1):57–64. [doi:10.1016/j.jacc.2005.03.051]

    Article  PubMed  Google Scholar 

  • Adamopoulos, S., Parissis, J.T., Iliodromitis, E.K., Paraskevaidis, I., Tsiapras, D., Farmakis, D., Karatzas, D., Gheorghiade, M., Filippatos, G.S., Kremastinos, D.T., 2006. Effects of levosimendan versus dobutamine on inflammatory and apoptotic pathways in acutely decompensated chronic heart failure. Am. J. Cardiol., 98(1):102–106. [doi:10.1016/j.amjcard.2006.01.068]

    Article  PubMed  CAS  Google Scholar 

  • Alhashemi, J.A., Alotaibi, Q.A., Abdullah, G.M., Shalabi, S.A., 2009. Levosimendan vs dobutamine in septic shock. J. Crit. Care, 24(3):e14. [doi:10.1016/j.jcrc.2009.06.006]

    Article  PubMed  Google Scholar 

  • Alvarez, J., Taboada, M., Rodríguez, J., Caruezo, V., Bouzada, M., Campaña, O., Bascuas, B., Pérez-Paz, J., Ginesta, V., 2005. Hemodynamic effects of levosimendan following cardiac surgery. Rev. Esp. Anestesiol. Reanim., 52(7): 389–394.

    PubMed  CAS  Google Scholar 

  • Alvarez, J., Bouzada, M., Fernández, A.L., Caruezo, V., Taboada, M., Rodríguez, J., Ginesta, V., Rubio, J., García-Bengoechea, J.B., González-Juanatey, J.R., 2006. Hemodynamic effects of levosimendan compared with dobutamine in patients with low cardiac output after cardiac surgery. Rev. Esp. Cardiol., 59(4):338–345 (in Spanish). [doi:10.1157/13087055]

    Article  PubMed  Google Scholar 

  • Bayram, M., de Luca, L., Massie, M.B., Gheorghiade, M., 2005. Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes. Am. J. Cardiol., 96(6A):47G–58G. [doi:10.1016/j.amjcard.2005.07.021]

    Article  PubMed  CAS  Google Scholar 

  • Bergh, C.H., Andersson, B., Dahlstrom, U., Forfang, K., Kivikko, M., Sarapohja, T., Ullman, B., Wikstrom, G., 2010. Intravenous levosimendan vs. dobutamine in acute decompensated heart failure patients on β-blockers. Eur. J. Heart Fail., 12(4):404–410. [doi:10.1093/eurjhf/hfq032]

    Article  CAS  Google Scholar 

  • Bonios, M.J., Terrovitis, J.V., Drakos, S.G., Katsaros, F., Pantsios, C., Nanas, S.N., Kanakakis, J., Alexopoulos, G., Toumanidis, S., Anastasiou-Nana, M., et al., 2012. Comparison of three different regimens of intermittent inotrope infusions for end stage heart failure. Int. J. Cardiol., 159(3):225–229. [doi:10.1016/j.ijcard.2011.03.013]

    Article  PubMed  Google Scholar 

  • Cleland, J.G.F., Freemantle, N., Coletta, A.P., Clark, A.L., 2006. Clinical trials update from the American Heart Association: REPAIR-AMI, ASTAMI, JELIS, MEGA, REVIVE-II, SURVIVE, and PROACTIVE. Eur. J. Heart Fail., 8(1):105–110. [doi:10.1016/j.ejheart.2005.12.003]

    Article  PubMed  CAS  Google Scholar 

  • Costanzo, M.R., Johannes, R.S., Pine, M., Gupta, V., Saltzberg, M., Hay, J., Yancy, C.W., Fonarow, G.C., 2007. The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database. Am. Heart J., 154(2):267–277. [doi:10.1016/j.ahj.2007.04.033]

    Article  PubMed  CAS  Google Scholar 

  • de Backer, D., Biston, P., Devriendt, J., Madl, C., Chochrad, D., Aldecoa, C., Brasseur, A., Defrance, P., Gottignies, P., Vincent, J.L., 2010. Comparison of dopamine and norepinephrine in the treatment of shock. N. Engl. J. Med., 362(9):779–789. [doi:10.1056/NEJMoa0907118]

    Article  PubMed  Google Scholar 

  • Delaney, A., Bradford, C., McCaffrey, J., Bagshaw, S.M., Lee, R., 2010. Levosimendan for the treatment of acute severe heart failure: a meta-analysis of randomized controlled trials. Int. J. Cardiol., 138(3):281–289. [doi:10.1016/j.ijcard.2008.08.020]

    Article  PubMed  Google Scholar 

  • Dellinger, R.P., Levy, M.M., Carlet, J.M., Bion, J., Parker, M.M., Jaeschke, R., Reinhart, K., Angus, D.C., Brun-Buisson, C., Beale, R., et al., 2008. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Crit. Care Med., 36(1): 296–327. [doi:10.1097/01.CCM.0000298158.12101.41]

    Article  PubMed  Google Scholar 

  • Dickstein, K., Cohen-Solal, A., Filippatos, G., McMurray, J.J., Ponikowski, P., Poole-Wilson, P.A., Strömberg, A., van Veldhuisen, D.J., Atar, D., Hoes, A.W., et al., 2008. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur. Heart J., 29(19): 2388–2442. [doi:10.1093/eurheartj/ehn309]

    Article  PubMed  CAS  Google Scholar 

  • Duygu, H., Ozerkan, F., Nalbantgil, S., Zoghi, M., Akilli, A., Akin, M., Nazli, C., Ergene, O., 2008a. Effect of levosimendan on E/E’ ratio in patients with ischemic heart failure. Int. J. Cardiol., 1123 (2):201–203. [doi:10.1016/j.ijcard.2006.11.145]

    Article  PubMed  Google Scholar 

  • Duygu, H., Turk, U., Ozdogan, O., Akyuz, S., Kirilmaz, B., Alioglu, E., Gunduz, R., Bozkaya, Y.T., Turkoglu, C., Payzin, S., 2008b. Levosimendan versus dobutamine in heart failure patients treated chronically with carvedilol. Cardiovasc. Ther., 26(3):182–188. [doi:10.1111/j.1755-5922.2008.00050.x]

    Article  PubMed  CAS  Google Scholar 

  • Follath, F., 2009. Newer treatments for decompensated heart failure: focus on levosimendan. Drug Des. Devel. Ther., 3:73–78. [doi:10.2147/DDDT.S3097]

    Article  PubMed  CAS  Google Scholar 

  • Follath, F., Hinkka, S., Jager, D., Just, H., Mitrovic, V., Papp, J.G., Peuhkurinen, K., Sandell, E., Takkunen, O., Lehtonen, L., 1999. Dose-ranging and safety with intravenous levosimendan in low-output heart failure: experience in three pilot studies and outline of the levosimendan infusion versus dobutamine (LIDO) trial. Am. J. Cardiol., 83(12B):21I–25I. [doi:10.1016/S0002-9149(99)00314-8]

    Article  Google Scholar 

  • Follath, F., Cleland, J.G., Just, H., Papp, J.G., Scholz, H., Peuhkurinen, K., Harjola, V.P., Mitrovic, V., Abdalla, M., Sandell, E.P., et al., 2002. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low output heart failure (the LIDO study): a randomized double-blind trial. Lancet, 360(9328):196–202. [doi:10.1016/S0140-6736(02)09455-2]

    Article  PubMed  CAS  Google Scholar 

  • Haikala, H., Nissinen, E., Etemadzadeh, E., Levijoki, J., Lindén, I.B., 1995. Troponin C-mediated calcium sensitization induced by levosimendan does not impair relaxation. J. Cardiovasc. Pharmacol., 25(5):794–801. [doi:10.1097/00005344-199505000-00016]

    Article  PubMed  CAS  Google Scholar 

  • Haynes, R.B., McKibbon, K.A., Wilczynski, N.L., Walter, S.D., Were, S.R., 2005. Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey. BMJ, 330(7501):1179. [doi:10.1136/bmj.38446.498542.8F]

    Article  PubMed  Google Scholar 

  • Higgins, J.P., Thompson, S.G., Deeks, J.J., Altman, D.G., 2003. Measuring inconsistency in meta-analyses. BMJ, 327(7414):557–560. [doi:10.1136/bmj.327.7414.557]

    Article  PubMed  Google Scholar 

  • Hunt, S.A., Abraham, W.T., Chin, M.H., Feldman, A.M., Francis, G.S., Ganiats, T.G., Jessup, M., Konstam, M.A., Mancini, D.M., Michl, K., et al., 2005. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation, 112(12): e154–e235. [doi:10.1161/CIRCULATIONAHA.105.167586]

    Article  PubMed  Google Scholar 

  • Iyisoy, A., Celik, T., Celik, M., Bugan, B., Yaman, H., 2010. Comparative effects of levosimendan and dobutamine infusion on p wave dispersion in patients with acute decompensated heart failure. Turkish J. Med. Sci., 40(5): 761–770.

    CAS  Google Scholar 

  • Kaheinen, P., Pollesello, P., Levijoki, J., Haikala, H., 2001. Levosimendan increases diastolic coronary flow in isolated guinea-pig heart by opening ATP-sensitive potassium channels. J. Cardiovasc. Pharmacol., 37(4):367–374. [doi:10.1097/00005344-200104000-00003]

    Article  PubMed  CAS  Google Scholar 

  • Landoni, G., Mizzi, A., Biondi-Zoccai, G., Bignami, E., Prati, P., Ajello, V., Marino, G., Guarracino, F., Zangrillo, A., 2010a. Levosimendan reduces mortality in critically ill patients. A meta-analysis of randomized controlled studies. Minerva Anestesiol., 76(4):276–286.

    PubMed  CAS  Google Scholar 

  • Landoni, G., Mizzi, A., Biondi-Zoccai, G., Bruno, G., Bignami, E., Corno, L., Zambon, M., Gerli, C., Zangrillo, A., 2010b. Reducing mortality in cardiac surgery with levosimendan: a meta-analysis of randomized controlled trials. J. Cardiothorac. Vasc. Anesth., 24(1):51–57. [doi:10.1053/j.jvca. 2009.05.031]

    Article  PubMed  Google Scholar 

  • Landoni, G., Biondi-Zoccai, G., Greco, M., Greco, T., Bignami, E., Morelli, A., Guarracino, F., Zangrillo, A., 2012. Effects of levosimendan on mortality and hospitalization. A meta-analysis of randomized controlled studies. Crit. Care Med., 40(2):634–646. [doi:10.1097/CCM.0b013e318232962a]

    Article  PubMed  CAS  Google Scholar 

  • Lehtonen, L., Sundberg, S., 2002. The contractility enhancing effect of the calcium sensitizer levosimendan is not attenuated by carvedilol in healthy subjects. Eur. J. Clin. Pharmacol., 58(7):449–452. [doi:10.1007/s00228-002-0500-3]

    Article  PubMed  CAS  Google Scholar 

  • Levin, R., Degrange, M.A., Del-Mazo, C., Porcile, R., Tanus, E., Blanco, N., Salvagio, F., Botbol, L., Milman, V., 2008a. Superiority of levosimendan over dobutamine in low cardiac output syndrome after aortic valve replacement. Circulation, 118:E231.

    Google Scholar 

  • Levin, R., Degrange, M.A., Porcile, R., Salvagio, F., Blanco, N., Botbol, A.L., Tanus, E., Del Mazo, C.D., 2008b. The calcium sensitizer levosimendan gives superior results to dobutamine in postoperative low cardiac output syndrome. Rev. Esp. Cardiol., 61(5):471–479. [doi:10.1157/13119990]

    Article  PubMed  Google Scholar 

  • Levin, R., Porcile, R., Salvagio, F., Mazo, C.D., Botbol, A., Tanus, E., Blanco, N., Degrange, M., 2009. Levosimendan reduces mortality in postoperative low cardiac output syndrome after coronary surgery. Circulation, 120:S987.

    Article  Google Scholar 

  • Maharaj, R., Metaxa, V., 2011. Levosimendan and mortality after coronary revascularisation: a meta-analysis of randomized controlled trials. Crit. Care, 15(3):R140. [doi:10.1186/cc10263]

    Article  PubMed  Google Scholar 

  • McMurray, J.J., Adamopoulos, S., Anker, S.D., Auricchio, A., Böhm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., Gomez-Sanchez, M.A., et al., 2012. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur. J. Heart Fail., 14(8):803–869. [doi:10.1093/eurjhf/hfs105]

    Article  PubMed  CAS  Google Scholar 

  • Mebazaa, A., Nieminen, M.S., Packer, M., Cohen-Solal, A., Kleber, F.X., Pocock, S.J., Thakkar, R., Padley, R.J., Poder, P., Kivikko, M., 2007. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial. JAMA, 297(17): 1883–1891. [doi:10.1001/jama.297.17.1883]

    Article  PubMed  CAS  Google Scholar 

  • Mebazaa, A., Pitsis, A.A., Rudiger, A., Toller, W., Longrois, D., Ricksten, S.E., Bobek, I., de Hert, S., Wieselthaler, G., Schirmer, U., et al., 2010. Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery. Crit. Care, 14(2):201. [doi:10.1186/cc8153]

    Article  PubMed  Google Scholar 

  • Mebazaa, A., Parissis, J., Porcher, R., Gayat, E., Nikolaou, M., Boas, F.V., Delgado, J.F., Follath, F., 2011. Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods. Intensive Care Med., 37(2):290–301. [doi:10.1007/s00134-010-2073-4]

    Article  PubMed  Google Scholar 

  • Metra, M., Nodari, S., D’Aloia, A., Muneretto, C., Robertson, A.D., Bristow, M.R., Dei Cas, L., 2002. β-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. J. Am. Coll. Cardiol., 40(7):1248–1258. [doi:10.1016/S0735-1097(02)02134-4]

    Article  PubMed  CAS  Google Scholar 

  • Morelli, A., de Castro, S., Teboul, J.L., Singer, M., Rocco, M., Conti, G., de Luca, L., di Angelantonio, E., Orecchioni, A., Pandian, N.G., et al., 2005. Effects of levosimendan on systemic and regional hemodynamics in septic myocardial depression. Intensive Care Med., 31(5):638–644. [doi:10.1007/s00134-005-2619-z]

    Article  PubMed  Google Scholar 

  • Nieminen, M.S., Akkila, J., Hasenfuss, G., Kleber, F.X., Lehtonen, L.A., Mitrovic, V., Nyquist, O., Remme, W.J., 2000. Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J. Am. Coll. Cardiol., 36(6): 1903–1912. [doi:10.1016/S0735-1097(00)00961-X]

    Article  PubMed  CAS  Google Scholar 

  • Pacold, I., Kleinman, B., Gunnar, R., Loeb, H.S., 1983. Effects of low-dose dobutamine on coronary hemodynamics, myocardial metabolism and anginal threshold in patients with coronary artery disease. Circulation, 68(5):1044–1050. [doi:10.1161/01.CIR.68.5.1044]

    Article  PubMed  CAS  Google Scholar 

  • Parissis, J.T., Rafouli-Stergiou, P., Stasinos, V., Psarogiannakopoulos, P., Mebazaa, A., 2010. Inotropes in cardiac patients: update 2011. Curr. Opin. Crit. Care, 16(5): 432–441. [doi:10.1097/MCC.0b013e32833e10fb]

    Article  PubMed  Google Scholar 

  • Ribeiro, R.A., Rohde, L.E., Polanczyk, C.A., 2010. Levosimendan in acute decompensated heart failure: systematic review and meta-analysis. Arq. Bras. Cardiol., 95(2):230–237. [doi:10.1590/S0066-782X2010005000072]

    Article  PubMed  CAS  Google Scholar 

  • Samimi-Fard, S., Garcia-Gonzalez, M.J., Dominguez-Rodriguez, A., Abreu-González, P., 2008. Effects of levosimendan versus dobutamine on long-term survival of patients with cardiogenic shock after primary coronary angioplasty. Int. J. Cardiol., 127(2):284–287. [doi:10.1016/j.ijcard.2007.04.143]

    Article  PubMed  Google Scholar 

  • Singer, M., 2007. Catecholamine treatment for shock-equally good or bad? Lancet, 370(9588):636–637. [doi:10.1016/S0140-6736(07)61317-8]

    Article  PubMed  Google Scholar 

  • Swedberg, K., Cleland, J., Dargie, H., Drexler, H., Follath, F., Komajda, M., Tavazzi, L., Smiseth, O.A., Gavazzi, A., Haverich, A., et al., 2005. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur. Heart J., 26(11):1115–1140. [doi:10.1093/eurheartj/ehi204]

    Article  PubMed  Google Scholar 

  • Tavares, M., Rezlan, E., Vostroknoutova, I., Khouadja, H., Mebazaa, A., 2008. New pharmacologic therapies for acute heart failure. Crit. Care. Med., 36(1):S112–S120. [doi:10.1097/01.CCM.0000296810.74724.8D]

    Article  PubMed  CAS  Google Scholar 

  • Thackray, S., Easthaugh, J., Freemantle, N., Cleland, J.G., 2002. The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure-a meta-regression analysis. Eur. J. Heart Fail., 4(4):515–529. [doi:10.1016/S1388-9842(02)00041-7]

    Article  PubMed  CAS  Google Scholar 

  • Vaitsis, J., Michalopoulou, H., Thomopoulos, C., Massias, S., Stamatis, P., 2009. Use of levosimendan in myocardial dysfunction due to sepsis. Crit. Care, 13(S1):165. [doi:10.1186/cc7329]

    Article  Google Scholar 

  • Wang, L., Cui, L., Wei, J.P., Li, G.P., Qi, G.X., Hao, Y.M., Wang, W.Z., Li, H.M., Liu, J., Jiang, D.J., et al., 2010. Efficacy and safety of intravenous levosimendan compared with dobutamine in decompensated heart failure. Chin. J. Cardiovasc. Dis., 38(6):527–530 (in Chinese).

    Google Scholar 

  • Wong, S.S., Wilczynski, N.L., Haynes, R.B., 2006. Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE. J. Med. Libr. Assoc., 94(1):41–47.

    PubMed  Google Scholar 

  • Yilmaz, M.B., Yontar, C., Erdem, A., Karadas, F., Yalta, K., Turgut, O.O., Yilmaz, A., Tandogan, I., 2009. Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure. Heart Vessels, 24(1):16–21. [doi:10.1007/s00380-008-1077-2]

    Article  PubMed  Google Scholar 

  • Yontar, O.C., Yilmaz, M.B., Yalta, K., Erdem, A., Tandoganet, I., 2010. Acute effects of levosimendan and dobutamine on QRS duration in patients with heart failure. Arq. Bras. Cardiol., 95(6):738–742. [doi:10.1590/S0066-782X2010005000143]

    Article  PubMed  CAS  Google Scholar 

  • Zairis, M.N., Apostolatos, C., Anastasiadis, P., Mytas, D., Katsaris, C., Kouris, N., Grassos, H., Karidis, K., Adamopoulou, E., Argyrakis, S., et al., 2004. The effect of a calcium sensitizer or an inotrope or none in chronic low output decompensated heart failure: results from the calcium sensitizer or inotrope or none in low output heart failure study (CASINO). J. Am. Coll. Cardiol., 43(5): A206. [doi:10.1016/S0735-1097(04)90879-0]

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, the First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, 310006, China

    Xuan Huang

  2. Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, 310006, China

    Shu Lei, Mei-fei Zhu, Rong-lin Jiang, Li-quan Huang, Guo-lian Xia & Yi-hui Zhi

Authors
  1. Xuan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shu Lei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mei-fei Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rong-lin Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Li-quan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guo-lian Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yi-hui Zhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shu Lei.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huang, X., Lei, S., Zhu, Mf. et al. Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials. J. Zhejiang Univ. Sci. B 14, 400–415 (2013). https://doi.org/10.1631/jzus.B1200290

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1631/jzus.B1200290

Key words

CLC number

Search

Navigation