Beta-Adrenergic Blockade in Critical Illness

Bruning, Rebecca S.; Dykes, Hannah; Jones, Timothy W.; Wayne, Nathaniel B.; Newsome, Andrea Sikora

doi:10.3389/fphar.2021.735841

Cited by 17 publications

(10 citation statements)

References 151 publications

(197 reference statements)

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“…β-Blockers have been shown to have a positive and beneficial effect in the treatment of cardiovascular diseases, [11][12][13][14] and the use of β-blockers has expanded to include the acute management of critically ill patients. [15][16][17] The β-receptor is a G-proteincoupled receptor found throughout the body that exerts physiological mechanisms via adrenaline and noradrenaline, following stimulation of the sympathetic nervous system. 3 In patients with AMI, β-blockers exert pharmacological mechanisms by lowering the calcium and cyclic adenosine monophosphate levels through the inhibition of chronotropic and inotropic effects, resulting in lowered heart rate, cardiac contractility, and blood pressure, and thereby reducing chest pain and the risk of complications associated with AMI.…”

Section: Discussionmentioning

confidence: 99%

“…β‐Blockers have been shown to have a positive and beneficial effect in the treatment of cardiovascular diseases, 11–14 and the use of β‐blockers has expanded to include the acute management of critically ill patients 15–17 . The β‐receptor is a G‐protein‐coupled receptor found throughout the body that exerts physiological mechanisms via adrenaline and noradrenaline, following stimulation of the sympathetic nervous system 3 .…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Impact of Early Administration of β‐Blockers in Critically Ill Patients with Acute Myocardial Infarction

Zhang,

Wang,

Hao

et al. 2023

The Journal of Clinical Pharma

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In critically ill patients with acute myocardial infarction (AMI), the relationship between the early administration of β‐blockers and the risks of in‐hospital and long‐term mortality remains controversial. Furthermore, there are conflicting evidences for the efficacy of the early administration of intravenous followed by oral β‐blockers in AMI. We conducted a retrospective analysis of critically ill patients with AMI who received the early administration of β‐blockers within 24 hours of admission. The data were extracted from the Medical Information Mart for Intensive Care IV database. We enrolled 2467 critically ill patients with AMI in the study, with 1355 patients who received the early administration of β‐blockers and 1112 patients who were non‐users. Kaplan‐Meier survival analysis and Cox proportional hazards models showed that the early administration of β‐blockers was associated with a lower risk of in‐hospital mortality (adjusted hazard ratio [aHR] 0.52; 95% confidence interval [95%CI] 0.42‐0.64), 1‐year mortality (aHR 0.54, 95%CI 0.47‐0.63), and 5‐year mortality (aHR 0.60, 95%CI 0.52‐0.69). Furthermore, the early administration of both oral β‐blockers and intravenous β‐blockers followed by oral β‐blockers may reduce the mortality risk, compared with non‐users. The risks of in‐hospital and long‐term mortality were significantly decreased in patients who underwent revascularization with the early administration of β‐blockers. We found that the early administration of β‐blockers could lower the risks of in‐hospital and long‐term mortality. Furthermore, the early administration of both oral β‐blockers and intravenous β‐blockers followed by oral β‐blockers may reduce the mortality risk, compared with non‐users. Notably, patients who underwent revascularization with the early administration of β‐blockers showed the lowest risks of in‐hospital and long‐term mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Early Administration of β‐Blockers in Critically Ill Patients with Acute Myocardial Infarction

Zhang,

Wang,

Hao

et al. 2023

The Journal of Clinical Pharma

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“…ACI has been shown to have effects on both the protein and glucose metabolism [ 29 , 30 ], leading to the inclusion of glucose and lactate measurements in control treatment guidelines for ACI [ 31 ]. Indeed, blockers of beta-adrenergic signalling have been shown to mitigate critical illness in multiple clinical trials [ 32 ], yet a deep mechanistic understanding of the molecular regulation leading to the onset of this condition is lacking, particularly for the role of endothelial metabolism, with the potential to open new avenues for novel drug interventions.…”

Section: Introductionmentioning

confidence: 99%

Metabolic Response in Endothelial Cells to Catecholamine Stimulation Associated with Increased Vascular Permeability

Lomana

Vilhjalmsson

McGarrity

et al. 2022

IJMS

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Disruption to endothelial cell homeostasis results in an extensive variety of human pathologies that are particularly relevant to major trauma. Circulating catecholamines, such as adrenaline and noradrenaline, activate endothelial adrenergic receptors triggering a potent response in endothelial function. The regulation of the endothelial cell metabolism is distinct and profoundly important to endothelium homeostasis. However, a precise catalogue of the metabolic alterations caused by sustained high catecholamine levels that results in endothelial dysfunction is still underexplored. Here, we uncover a set of up to 46 metabolites that exhibit a dose–response relationship to adrenaline-noradrenaline equimolar treatment. The identified metabolites align with the glutathione-ascorbate cycle and the nitric oxide biosynthesis pathway. Certain key metabolites, such as arginine and reduced glutathione, displayed a differential response to treatment in early (4 h) compared to late (24 h) stages of sustained stimulation, indicative of homeostatic metabolic feedback loops. Furthermore, we quantified an increase in the glucose consumption and aerobic respiration in endothelial cells upon catecholamine stimulation. Our results indicate that oxidative stress and nitric oxide metabolic pathways are downstream consequences of endothelial cell stimulation with sustained high levels of catecholamines. A precise understanding of the metabolic response in endothelial cells to pathological levels of catecholamines will facilitate the identification of more efficient clinical interventions in trauma patients.

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“…β -Adrenergic blockade can allow to control heart rate and minimize adversities owing to sympathetic overstimulation [8] [9] .…”

Section: Introductionmentioning

confidence: 99%

“…β -Adrenergic blockade can allow to control heart rate and minimize adversities owing to sympathetic overstimulation. [ 8 ] β -blockers can modulate the intrinsic response to β -adrenergic overstimulation to control the heart rate effectively. [ 9 ] There are increasing reports on the beneficial effects of β -blockers in the treatment of septic shock and other severe terminal illnesses, which indicates an advantageous effect on mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of efficacy and safety of esmolol in treating patients with septic shock

Hou¹,

Cai²,

Li³

et al. 2022

Medicine

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Background: In septic shock cases, tachycardia and a hyperdynamic hemodynamic profile are characteristics of the condition. It has been reported that using beta antagonist esmolol constitutes a form of treatment to reduce heart rate to improve diastolic filling time and elevate cardiac output, which reduces vasopressor support. Still, there are controversial results. Therefore, in this study, the primary objective is to perform a meta-analysis by systematically evaluating the efficiency and security of using esmolol to treat septic shocks. Methods: A systematic literature search for relevant randomized controlled trials that report evaluations on the efficiency and safety of using esmolol to treat septic shock patients from their inception to February 2022 will be conducted in three databases containing publications in Chinese language (WanFang, Chinese BioMedical Literature Database, and China National Knowledge Infrastructure) and four databases containing English language publications (Cochrane Library, PubMed, Web of Science, and EMBASE). The screening of the relevant studies will be performed by a pair of authors independently, and the screening involves examining the title, abstract and full-text stages, data extraction, and bias risk assessment. The results are summarized through the fixed-effects and random-effects models, the respective models will be utilized for data pooling according to the heterogeneity of studies that will be included. Moreover, publication bias is assessed if more than ten studies are considered. Results: The results are a high-quality synthesis of the most recent evidence for esmolol usage in septic shock treatment. Conclusion: Up-to-date evidence will be provided through the results of this systematic review related to assessing the efficacy and safeness of esmolol usage in treating septic shock. Ethics and dissemination: Ethical permissions are not required as prepublished data are used. OSF registration number: DOI 10.17605/OSF.IO/SKEZ7

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Beta-Adrenergic Blockade in Critical Illness

Cited by 17 publications

References 151 publications

Prognostic Impact of Early Administration of β‐Blockers in Critically Ill Patients with Acute Myocardial Infarction

Prognostic Impact of Early Administration of β‐Blockers in Critically Ill Patients with Acute Myocardial Infarction

Metabolic Response in Endothelial Cells to Catecholamine Stimulation Associated with Increased Vascular Permeability

Evaluation of efficacy and safety of esmolol in treating patients with septic shock

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