The pros and cons of beta-blockers in sepsis:Where do we stand in 2024?  

作　　者：Daniel De Backer Dechang Chen 

机构地区：[1]Department of Intensive Care,CHIREC Hospitals,Universite Libre de Bruxelles,Brussels B-1160,Belgium [2]Department of Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,China

出　　处：《Journal of Intensive Medicine》2025年第1期32-34,共3页重症医学(英文)

摘　　要：Septic shock is associated with severe vasoplegia, increased permeability, maldistribution of regional blood flows, and microvascular alterations. Hemodynamic management includes fluid and vasopressor agents and, in selected cases, inotropic agents. However, several patients remain tachycardic after initial resuscitation. Tachycardia is frequently observed in sepsis and is associated with a poor outcome.[1] Given the negative impact of tachycardia, the use of short-acting beta-blockers was proposed.[2] Of note, tachycardia was suggested to be protective in patients with increased lactate levels whereas opposite effects were observed in patients with normal lactate levels.[3] The impact of tachycardia should hence not be evaluated without looking at tissue perfusion. In addition, patients in septic shock with elevated left ventricular (LV) ejection fraction (EF) at echocardiography present an increased risk of death. In a retrospective single-center study including 1014 patients, an elevation in LVEF was found to be independently correlated with mortality (odds ratio=3.90 [2.09-7.40]).[4] In another cohort of patients with sepsis and septic shock, the relationship between LVEF and mortality showed a U-shaped pattern, with severely impaired (<25%) and elevated (≥70%) EF, both being independently associated with an increased risk of death.[5] In tachycardic hyperkinetic hearts, beta-blockers are expected to be particularly useful. Several randomized controlled trials (RCTs) evaluated the impact of short-term beta-blockers to control tachycardia in septic patients, sometimes with diverging results. In this review, we analyze the results of three main RCTs to discuss whether there is a place for the use of beta-blockers in septic patients with tachycardia.[2,6,7].

关 键 词：TACHYCARDIA ELEVATED SEPSIS 

分 类 号：R73[医药卫生—肿瘤]