Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock

Morelli, Andrea; Donati, Abele; Ertmer, Christian; Rehberg, Sebastian; Kampmeier, Tim; Orecchioni, Alessandra; D’Egidio, Annalia; Cecchini, Valeria; Landoni, Giovanni; Pietropaoli, P; Westphal, Martin; Venditti, Mario; Mebazaa, Alexandre; Singer, Mervyn

doi:10.1097/ccm.0b013e31828a678d

Cited by 109 publications

(116 citation statements)

References 37 publications

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“…[26][27][28][29] A single-center trial 30 demonstrating improved mortality among patients with septic shock and sinus tachycardia randomized to receive the BB esmolol further supports our finding that BBs may have clinical benefit during sepsis. Although potential mechanisms for beneficial effects of BBs during sepsis are unclear, experimental data support enhanced journal.publications.chestnet.org microvascular, 31 antiinflammatory, 32 and gut mucosal integrity 33 with use of BBs during sepsis.…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Walkey

Evans

Winter

et al. 2016

Chest

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BACKGROUND: Atrial fibrillation (AF) during sepsis is associated with increased morbidity and mortality, but practice patterns and outcomes associated with rate-and rhythm-targeted treatments for AF during sepsis are unclear.METHODS: This was a retrospective cohort study using enhanced billing data from approximately 20% of United States hospitals. We identified factors associated with IV AF treatments (b-blockers [BBs], calcium channel blockers [CCBs], digoxin, or amiodarone) during sepsis. We used propensity score matching and instrumental variable approaches to compare mortality between AF treatments.RESULTS: Among 39,693 patients with AF during sepsis, mean age was 77 AE 11 years, 49% were women, and 76% were white. CCBs were the most commonly selected initial AF treatment during sepsis (14,202 patients [36%]), followed by BBs (11,290 [28%]), digoxin (7,937 [20%]), and amiodarone (6,264 [16%]). Initial AF treatment selection differed according to geographic location, hospital teaching status, and physician specialty. In propensity-matched analyses, BBs were associated with lower hospital mortality when compared with CCBs (n ¼ 18,720; relative risk [RR], 0.92; 95% CI, 0.86-0.97), digoxin (n ¼ 13,994; RR, 0.79; 95% CI, 0.75-0.85), and amiodarone (n ¼ 5,378; RR, 0.64; 95% CI, 0.61-0.69). Instrumental variable analysis showed similar results (adjusted RR fifth quintile vs first quintile of hospital BB use rate, 0.67; 95% CI, 0.58-0.79). Results were similar among subgroups with new-onset or preexisting AF, heart failure, vasopressor-dependent shock, or hypertension.CONCLUSIONS: Although CCBs were the most frequently used IV medications for AF during sepsis, BBs were associated with superior clinical outcomes in all subgroups analyzed. Our findings provide rationale for clinical trials comparing the effectiveness of AF rate-and rhythm-targeted treatments during sepsis.

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Section: Discussionmentioning

confidence: 99%

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Walkey

Evans

Winter

et al. 2016

Chest

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“…Such cardiac performance was characterized by reduced heart rate, maintained cardiac output and decreased dP/dt MAX (50,51). Also there are some evidence that esmolol administration was associated with reduced norepinephrine requirement (52). The most important clinical trial that has been published is probably the one performed by Morelli and colleagues.…”

Section: Beta-blockersmentioning

confidence: 99%

Vasoactive agents for the treatment of sepsis

Zhang

Chen

2016

Ann. Transl. Med.

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The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myocardium to calcium. Some preliminary studies showed a promising result of levosimendan on reducing mortality.

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“…septik şok olgularında esmolol infüzyonunun kardiyak stroke volümü artırdığını, mikrovasküler kan akımını koruduğunu ve norepinefrin gereksinimini azalttığını bildirmişlerdir. 7 Way ve ark. milrinon ve esmolol kombinasyonunun ciddi sepsis olgularında kardiyak fonksiyonu ve 28 günlük mortaliteyi azalttığını bildirmişlerdir.…”

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Esmolol in Sepsis

Koca¹

2018

Turkiye Klinikleri J Anest Reanim

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Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock

Abstract: This pilot study demonstrated that heart rate control by a titrated esmolol infusion in septic shock patients was associated with maintenance of stroke volume, preserved microvascular blood flow, and a reduction in norepinephrine requirements.

Cited by 109 publications

References 37 publications

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Vasoactive agents for the treatment of sepsis

Esmolol in Sepsis

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