The Effect of Esmolol on Tissue Perfusion and Clinical Prognosis of Patients with Severe Sepsis: A Prospective Cohort Study

Abstract

Purpose. This study was aimed at investigating the effect of esmolol on tissue perfusion and the clinical prognosis of patients with severe sepsis. Materials and Methods. One hundred fifty-one patients with severe sepsis were selected and divided into the esmolol group (n = 75) or the control group (n = 76), who received conventional antiseptic shock treatment. The esmolol group received a continuous infusion of esmolol via a central venous catheter, and their heart rate (HR) was maintained at 70–100 bpm over 72 hours. Results. The HR of all patients reached the target level within 72 hours of treatment for both groups. The effect of esmolol on PvaCO2 was only significant at 48 hours (P < 0.05). ScvO2 increased in the esmolol group and decreased in the control group (P < 0.01). Lac showed a linear downward trend over the treatment time, but the reduction was more significant in the control group at 48 hours (P < 0.05) between the two groups. Kaplan-Meier analysis showed a significantly shorter duration of mechanical ventilation in the esmolol group than in the control group (P < 0.05). Conclusions. Esmolol reduced the duration of mechanical ventilation in patients with severe sepsis, with no significant effect on circulatory function or tissue perfusion.

Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): study protocol for a randomized controlled trial

“…In addition, landiolol is started at a low dose of 1 mcg/kg/min (as supported by landiolol sepsis [ 49 ], postoperative [ 50 ], and heart failure studies [ 51 ]) and titration is performed conservatively at 20-min intervals (5 half-lives) [ 35 ]. The HR target should be reached within the first 24 h, as supported by published data [ 28 – 30 , 32 ].…”

“…Hence, novel therapeutic concepts are urgently needed. Recently, the use of beta-blockers during sepsis has been suggested [ 10 , 28 – 30 , 32 , 41 ]. This represents a true innovation, as current guidelines recommend beta-mimetics [ 40 ].…”

“…Morelli et al [ 10 ] (and later others [ 28 – 30 , 32 ]) showed that a HR reduction in patients with septic shock, after adequate resuscitation with fluids, vasopressors, and inotropes, was not associated with an increase in AEs and did not trigger an increase in vasopressor support. As in the original protocol by Morelli et al [ 10 ], the target HR in the present study is < 95 bpm, which is based on studies showing poorer patient outcomes when this threshold is exceeded and studies showing good tolerance after achieving this target with beta-blockers [ 7 , 11 , 45 – 48 ].…”

“…As in the original protocol by Morelli et al [ 10 ], the target HR in the present study is < 95 bpm, which is based on studies showing poorer patient outcomes when this threshold is exceeded and studies showing good tolerance after achieving this target with beta-blockers [ 7 , 11 , 45 – 48 ]. More recently, several studies conducted in China [ 28 – 30 , 32 ] that selected a similar HR target showed good tolerance of the beta-blocker treatment. Therefore, the HR target of < 95 bpm seems appropriate for further comparison and optimal with respect to feasibility and tolerance.…”

“…Despite concerns of hemodynamic decompensation, recent clinical studies using esmolol in patients with sepsis [ 10 , 25 – 34 ] suggest that control of HR can be safely achieved with beta1-selective beta-blockers. These studies reported a decrease in HR with limited reduction of cardiac output, improved stroke volume and lactate levels, and stabilization or improvement of organ dysfunction [ 10 , 28 – 30 , 32 ]. Furthermore, the combined use of beta-blockers and vasopressors appears to be safe and does not appear to increase the need for vasopressor support or impair microcirculation [ 26 , 27 , 34 ].…”