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Beta-blockers in septic shock: What is new?
Mickael Lescroart1,2,3, Benjamin Pequignot1,2,3, Antoine Kimmoun1,2,3
1Service de Médecine Intensive et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, University Hospital of Nancy-Brabois, Rue du Morvan, Vandœuvre-les-Nancy 54511, France.
Journal of Intensive Medicine
|February 15, 2023
Summary
Beta-blockers may improve septic shock prognosis by reducing sympathetic overactivation. While generally safe at low doses, specific agents like esmolol and landiolol are not recommended in the early phase.
Area of Science:
- Critical care medicine
- Pharmacology
- Cardiovascular physiology
Background:
- Septic shock involves sympathetic overactivation, potentially mitigated by beta-blockers.
- Animal studies suggest beta-blockers may maintain or increase cardiac output despite reduced heart rate.
- The hemodynamic mechanisms of beta-blockers in septic shock require further elucidation.
Purpose of the Study:
- To evaluate the potential benefits and optimal use of beta-blockers in managing septic shock.
- To review current evidence regarding the safety and efficacy of specific beta-blockers in septic shock patients.
Main Methods:
- Review of preclinical and clinical data on beta-blocker use in septic shock.
- Analysis of recent publications (2019-2021) focusing on beta1 receptor antagonists.
- Consideration of patient selection criteria and administration timing.
Main Results:
- Beta-blockers appear safe at low doses, but esmolol and landiolol are not advised in the early septic shock phase.
- Optimal administration timing is not established, but 12 hours post-vasopressor initiation in stable patients is suggested.
- Landiolol may be used in patients with normal or slightly depressed cardiac function under monitoring and can reduce arrhythmias.
Conclusions:
- Beta-blocker therapy in septic shock warrants careful consideration of timing and patient selection.
- Further randomized controlled trials are needed to confirm survival benefits and impact on organ failure.
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