Beta-blockers in septic shock: What is new?  

作　　者：Mickael Lescroart Benjamin Pequignot Antoine Kimmoun Thomas Klein Bruno Levy 

机构地区：[1]Service de Médecine Intensive et Réanimation Brabois,CHRU Nancy,Pôle Cardio-Médico-Chirurgical,University Hospital of Nancy-Brabois,Rue du Morvan,Vandoeuvre-les-Nancy 54511,France [2]INSERM U1116,Facultéde Médecine,Vandoeuvre-les-Nancy 54511,France [3]Universitéde Lorraine,Nancy 54000,France

出　　处：《Journal of Intensive Medicine》2022年第3期150-155,共6页重症医学（英文）

摘　　要：The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could improve the prognosis of patients in septic shock.Animal studies have demonstrated either a maintenance or increase in cardiac output(CO)despite the decrease in heart rate(HR)associated with improved myocardial performance.The mechanism by which𝛽-blockers alter hemodynamics in septic shock is debated;however,preclinical and clinical data show that𝛽-blockers are safe when started at a low dose.Recent publications(2019-2021)on adrenergic𝛽1 receptor antagonists used in septic shock indicate that esmolol and landiolol should not be used in the early phase.While there is no optimal timing for their administration,a minimum of 12 h after the initiation of vasopressor therapy in stabilized euvolemic patients is a reasonable option.Patients should have a normal cardiac function,although a slight depression is compatible with landiolol use under hemodynamic monitoring.Slow titration in patients who remain tachycardic is preferable to rapid titration.When used to decrease HR,landiolol is also effective in reducing the incidence of new arrhythmias.Results of a well-performed and well-powered randomized controlled trial(RCT)demonstrating a positive effect on survival-or at least on hard surrogates such as the incidence/duration of organ failure-are pending.

关 键 词：Septic shock Adrenergic𝛽β_(1)receptor antagonists NOREPINEPHRINE 

分 类 号：R459.7[医药卫生—急诊医学]