Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock

Borggrefe, Martin; Rulíšek, Jan; Leden, Pavel; Zakharchenko, Michal; Otáhal, Michal; Bartáková, Hana; Kořínek, Josef

doi:10.1007/s00508-012-0209-y

Cited by 61 publications

(51 citation statements)

References 17 publications

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“…Esmolol tended to increase stroke volume which resulted in no significant decrease in CO or CI during esmolol administration. A continuous betablockade did not induce significant changes in DO 2 , VO 2 or OER [97,98]. A similar impact on haemodynamics was reported by Morelli who used a very low dosage of 100 mg h -1 as part of the applied EGDT protocol with no echocardiography or verification of the absence of contraindications to a betablocker.…”

Section: Beta-blockerssupporting

confidence: 50%

“…Nevertheless, the comparisons to control patients were fraught with high mortality in the control group while the haemodynamic monitoring did not include echocardiography [87]. Several limitations have to be considered including the absence of echocardiographic cardiac function evaluation and the exclusion of the valve and conduction disorders, prior to beta-blocker administration in septic shock patients [88,90]. The same limitations regarding the absence of echocardiographic screening of cardiac function and haemodynamics exist in all the case series on various antiarrhythmic agents in sepsis and septic shock patients.…”

Section: Discussionmentioning

confidence: 99%

“…Betablockers are the medication of choice for a wellselected cohort of septic shock patients [88,89]. In a recent paper, only 6% of septic shock patients with SV arrhythmias were medicated with betablockers [18].…”

Section: Beta-blockersmentioning

confidence: 99%

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Management of arrhythmia in sepsis and septic shock

Borggrefe¹,

Matoušek²,

Malý³

et al. 2017

Anaesthesiol Intensive Ther

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The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.

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Section: Beta-blockerssupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of arrhythmia in sepsis and septic shock

Borggrefe¹,

Matoušek²,

Malý³

et al. 2017

Anaesthesiol Intensive Ther

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“…Only one RCT enrolled a large number of patients (154) patients) 8 , while the other was smaller (41 patients) and published in Chinese language 11 . Other two peer-reviewed prospective studies 12,13 were fairly small (respectively 25 and 10 patients) and they did not include a control group. Therefore, in consideration of the imbalance in the sample size between these studies, the absence of a control group in two studies, a metaanalysis will be not meaningful at this stage.…”

Section: Discussionmentioning

confidence: 98%

Beta-blocker use in severe sepsis and septic shock: a systematic review

Sanfilippo

Santonocito

Morelli

et al. 2015

Current Medical Research and Opinion

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“…While it is theoretically plausible, experimental and clinical studies yielded conflicting results (5)(6)(7)48,49). Observational studies showed that esmolol, the most commonly used beta-blocker in septic shock, was associated with economization of cardiac work and oxygen consumption.…”

Section: Beta-blockersmentioning

confidence: 99%

Vasoactive agents for the treatment of sepsis

Zhang

Chen

2016

Ann. Transl. Med.

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The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myocardium to calcium. Some preliminary studies showed a promising result of levosimendan on reducing mortality.

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Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock

Abstract: Saving the heart 30 beats/min did not demonstrate adverse impact on global haemodynamics in rates above 110/min. Using well titratable betablocker seems to be safe and cardioprotective in septic shock patients with high cardiac output.

Cited by 61 publications

References 17 publications

Management of arrhythmia in sepsis and septic shock

Management of arrhythmia in sepsis and septic shock

Beta-blocker use in severe sepsis and septic shock: a systematic review

Vasoactive agents for the treatment of sepsis

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