Levosimendan has been demonstrated to have potential utility in a range of critical illness scenarios. It must be acknowledged, however, that in each sphere of application, the evidence is incomplete or indicative rather than conclusive, and further clinical evaluation will be needed to substantiate the case for levosimendan and to refine the patient categories and dosage schedules likely to be associated with the greatest clinical benefit.

Evidence for a renal-protective action of levosimendan in preclinical experiments is persuasive but the clinical data set supporting a renal-protective effect rests on a limited number of studies, many of which are small and characterized by heterogeneities.

The results of those studies acquire significance only when pooled in meta-analyses but, addressed in that way, the findings are suggestive of a renal-protective effect of levosimendan in a range of cardiac low-output states that may be pertinent to the ICU setting.

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