Background: The incidence of sepsis continues to increase. Septic shock is a major cause of mortality in the United States and throughout the world. An adverse outcome of sepsis is cardiac dysfunction. Tachycardia increases the workload on the heart, which increases the metabolic demands required. It is imperative to identify new treatment options to help alleviate and manage the symptoms of sepsis. There are many potential benefits of beta-blockers for acutely ill patients. This includes a decreased oxygen demand related to a decreased heart rate (HR). This also results in reduced blood pressure and decreased workload of the heart. Will the administration of beta-blockers be effective at controlling heart rate and mitigating the harmful effects of beta-adrenergic receptor stimulation in patients with septic shock?
Methods: An extensive search was conducted using Medline-OVID, CINAHL, and Web of Science using the keywords: beta-blocker and septic shock. The search was narrowed to only articles in English published within the last two years. Articles that were relevant for data evaluating the use of beta-blockers in septic shock were assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).
Results: Two studies met inclusion criteria and were included in this systematic review. A randomized clinical trial with 336 participants demonstrated a decrease in 28-day mortality for septic shock patients receiving esmolol infusion. It also showed that esmolol was effective at reducing heart rate and maintaining it within desired levels while avoiding unwanted outcomes. A prospective observational pilot study evaluated 25 septic shock patients in the ICU. The study demonstrated a controlled heart rate with a titrated infusion of esmolol. It made evident a reduction in norepinephrine dosage, while maintaining microvascular blood flow and stroke volume.
Conclusion: A titrated infusion of esmolol has been shown to reduce mortality in patients with septic shock. These studies data support that the titrated administration of esmolol, a short acting beta-blocker, reduces HR and maintain it within a target range of 80-94bpm. Secondary outcomes support its use in patients with septic shock without significantly compromising the cardiac output of the patient and maintaining the microcirculation of blood flow.
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