Abstract: Levosimendan, a calcium sensitizer aimed at treating decompensated or refractory heart failure, exerts its positive inotropic effects independently of beta adrenergic receptor in cases of severe and intractable heart failure. Available evidences supports the concept that levosimendan is a safe and valid option in treating critically ill cardiovascular patients. Additional data from well-designed randomized prospective controlled trials in critically ill patients is warranted to appreciate the therapeutic role or roles for levosimendan in critically ill cardiovascular pateints.