Benefits of esmolol in adults with sepsis and septic shock: An updated meta-analysis of randomized controlled trials

Abstract

Background: Sepsis affects millions of patients annually, resulting in substantial health and economic burdens globally. The role of esmolol potentially plays in the treatment of sepsis and septic shock in adult patients remains controversial.Methods: We undertook a systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from their inception to May 12, 2022, for randomized controlled trials that evaluated the efficacy of esmolol for sepsis and septic shock. A random-effects meta-analysis was performed. Two investigators independently screened articles, extracted data, and assessed the quality of included studies.Results: Eight studies from 7 randomized controlled trials were included in our meta-analysis of 503 patients with sepsis and/or septic shock. Compared with standard treatment, esmolol significantly decreased 28-day mortality (risk ratio 0.68, 95% confidence interval [CI] 0.52-0.88; P = .004), heart rate (standardized mean difference [SMD] −1.83, 95% CI −2.95 to −0.70, P = .001), tumor necrosis factor-a (SMD −0.48, 95% CI −0.94 to −0.02, P = .04), and the troponin I level (SMD −0.59, 95% CI −1.02 to −0.16, P = .008) 24 hours after treatment. No significant effect was found in terms of length of intensive care unit stay; mean arterial pressure, lactic acid, central venous pressure, or central venous oxygen saturation, interleukin 6, or white blood cell levels; stroke volume index; or the PaO2/FiO2 ratio.Conclusions: Esmolol treatment may be safe and effective in decreasing 28-day mortality, controlling heart rate, and providing cardioprotective function, but has no effect on lung injury in patients with sepsis or septic shock after early fluid resuscitation. Improvement in cardiac function may be related to changes in serum inflammatory mediators. No significant adverse effects on tissue perfusion and oxygen utilization were observed. Abbreviations: CI = confidence interval, CENTRAL = the Cochrane Central Register of Controlled Trials, CVP = central venous pressure, HMGB-1 = high mobility group box-1, HR = heart rate, ICU = intensive care unit, IL-6 = interleukin 6, Lac = lactic acid, MAP = mean arterial pressure, RCT = randomized controlled trial, RR = risk ratio, ScvO2 = central venous oxygen saturation, SMD = standardized mean difference, SVI = stroke volume index, TNF-a = tumor necrosis factor-a, TnI = troponin I, WBC = white blood cell.

The concomitant use of ultra short beta-blockers with vasopressors and inotropes in critically ill patients with septic shock: A systematic review and meta-analysis of randomized controlled trials

“…Similarly, there was no notable distinction in the vasopressor requirements between the beta-blocker and control groups. In agreement with our findings, previous meta-analyses investigated beta-blockers, either esmolol or landiolol benefit in a patient with septic shock or sepsis found a significant reduction in the 28 days mortality and heart rate in the beta-blocker group compared to the control group ( Li et al, 2020 , Zhang et al, 2022 ), with no significant effect on the length of ICU stay ( Hasegawa et al, 2021 ).…”

Landiolol and Organ Failure in Patients With Septic Shock

“…Morelli et al reported the safety of a short-acting β-blocker, esmolol, in patients with septic shock and noted a markedly reduced adjusted hazard ratio (HR) mortality of 61% but as a nonprimary outcome and with a high mortality in the control group of more than 80%. A recent meta-analysis of 8 randomized studies using esmolol suggested that the 32% risk ratio decreased 28-day mortality, and a meta-analysis of 7 studies using either esmolol or landiolol in patients with sepsis and septic shock was associated with 32% lower 28-day mortality. Landiolol (Rapibloc, AOP Health) is a very short-acting β-blocker and is approximately 8 times more selective for the β 1 -receptor than esmolol .…”

Association between the β-blocker use and patients with sepsis: a cohort study

“…Third, it may be related to the role of β-blockers in regulating inflammatory response. β-blockers can down-regulate inflammatory mediators (e.g., TNF-α, IL-6, HMGB-1) in animal models of sepsis to reduce the inflammatory response ( 13 , 18 , 19 ) as well as inhibit cardiomyocyte apoptosis ( 20 , 21 ). In addition, β-blockers can activate the anti-inflammatory effects of cholecystokinin receptors and thus play a role in protecting the function of the intestinal barrier ( 18 ).…”