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Benefits of Beta-Blockade in Sepsis and Septic Shock: A Systematic Review

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Abstract

Background

Sepsis and septic shock are inflammatory disorders associated with high rates of mortality. Patients with sepsis and septic shock frequently become tachycardic as a result of the utilization of vasopressor therapy and cardiac overcompensation owing to hypotension, predisposing patients to an increased risk of atrial fibrillation. Previously, it was thought that beta-blocker therapy in patients with sepsis would exacerbate hypotension; however, recent studies have shown that may not be the case.

Objective

This review aims to ascertain whether beta-blocker therapy reduces heart rate in patients with sepsis without a corresponding decrease in blood pressure, and if beta-blockade has a beneficial effect on mortality.

Methods

Several databases including Cochrane, EMBASE, PubMed, SCOPUS, and Web of Science were scoured for trials pertaining to the utilization of beta-blockers in sepsis and septic shock, and trials that were either prospective or controlled were included in this review.

Results

In the initial search, 1839 articles were found, and those were subsequently reduced to 14 trials (five randomized controlled trials, nine non-randomized trials) that were deemed appropriate for inclusion in this review. All included trials displayed beneficial effects on heart rate without any detriments to blood pressure. Of the six trials that assessed mortality, four showed substantial benefits.

Conclusion

The majority of the trials assessed in this review displayed beneficial results for beta-blocker use in patients with sepsis. However, owing to the deficit of large-scale randomized controlled trials addressing this topic, further research is needed to ensure the veracity of these results.

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Acknowledgements

The authors acknowledge Nguyen Le for her assistance in assessing articles for this review.

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Authors and Affiliations

  1. Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, 1718 Pine Street, Abilene, TX, 79601, USA

    Young R. Lee, Michael Sadanand Seth, Dylan Soney & Hanyu Dai

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Correspondence to Young R. Lee.

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Funding

No sources of funding were received for the preparation of this systematic review.

Conflict of interest

Young R. Lee, Michael Sadanand Seth, Dylan Soney, and Hanyu Dai have no conflicts of interest that are directly relevant to the content of this systematic review.

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Lee, Y.R., Seth, M.S., Soney, D. et al. Benefits of Beta-Blockade in Sepsis and Septic Shock: A Systematic Review. Clin Drug Investig 39, 429–440 (2019). https://doi.org/10.1007/s40261-019-00762-z

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