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Annual Update in Intensive Care and Emergency Medicine 2015 pp 139–152Cite as

β-Blockers in Critically Ill Patients: From Physiology to Clinical Evidence

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Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2015 ((AUICEM,volume 2015))

Abstract

β-blockers are commonly used in the treatment of cardiovascular diseases and to reduce the risk of re-infarction and the related mortality after myocardial infarction [1]. In fact, they almost universally reduce myocardial oxygen consumption and hence the degree of cardiac ischemia. Two randomized controlled trials (RCT) demonstrated that the perioperative use of β-blockers could reduce the incidence of cardiac complications responsible for significant morbidity and mortality after cardiac surgery [2, 3]. However, these results were not confirmed in three subsequent RCTs and in a large cohort study [4–7]. Similarly, the Perioperative Ischemic Evaluation Study (POISE) found that individuals receiving metoprolol succinate 30 days before surgery had a reduced risk of postoperative myocardial infarction compared to the control group but an increased risk of stroke and death associated with an increased incidence of hypotension, bradycardia and bleeding [8]. Over the years, these surprising results led to different changes in practice guidelines; specifically, the recent 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend that perioperative β-blockers should be started only in patients considered to be at intermediate or high risk for myocardial ischemia [9].

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References

  1. Sanfilippo F, Santonocito C, Foex P (2014) Use of beta-blockers in non-cardiac surgery: an open debate. Minerva Anestesiol 80:482–494

    CAS  PubMed  Google Scholar 

  2. Mangano DT, Layug EL, Wallace A, Tateo I (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335:1713–1720

    Article  CAS  PubMed  Google Scholar 

  3. Poldermans D, Boersma E, Bax JJ et al (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 341:1789–1794

    Article  CAS  PubMed  Google Scholar 

  4. Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR (2005) Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg 41:602–609

    Article  CAS  PubMed  Google Scholar 

  5. Juul AB, Wetterslev J, Gluud C et al (2006) Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ 332:1482

    Article  PubMed Central  PubMed  Google Scholar 

  6. Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM (2005) Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 353:349–361

    Article  CAS  PubMed  Google Scholar 

  7. Yang H, Raymer K, Butler R, Parlow J, Roberts R (2006) The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 152:983–990

    Article  CAS  PubMed  Google Scholar 

  8. Devereaux PJ, Yang H, Yusuf S et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847

    Article  CAS  PubMed  Google Scholar 

  9. Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 64:e77–e137

    Article  PubMed  Google Scholar 

  10. Christensen S, Johansen MB, Tonnesen E et al (2011) Preadmission beta-blocker use and 30-day mortality among patients in intensive care: a cohort study. Crit Care 15:R87

    Article  PubMed Central  PubMed  Google Scholar 

  11. Novotny NM, Lahm T, Markel TA et al (2009) beta-Blockers in sepsis: reexamining the evidence. Shock 31:113–119

    Article  CAS  PubMed  Google Scholar 

  12. Stoelting RK, Hilller SC (2006) Alpha and beta-adrenergic receptor antagonists. In: Pharmacology & Physiology in Anesthetic Practice, 4th edn. Lippincott, Williams & Wilkins, Philadelphia, pp 321–337

    Google Scholar 

  13. Morelli A, Ertmer C, Westphal M et al (2013) Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA 310:1683–1691

    Article  PubMed  Google Scholar 

  14. Dellinger RP, Levy MM, Carlet JM et al (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36:296–327

    Article  PubMed  Google Scholar 

  15. Ginsberg F (2012) beta-blockers: more good news? Crit Care Med 40:2901–2902

    Article  PubMed  Google Scholar 

  16. Hamzaoui O, Teboul JL (2015) The role of beta-blockers in septic patients. Minerva Anestesiol (in press)

    Google Scholar 

  17. Rudiger A (2010) Beta-block the septic heart. Crit Care Med 38:608–S612

    Article  Google Scholar 

  18. Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F (2008) Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med 36:1701–1706

    Article  PubMed  Google Scholar 

  19. Gattinoni L, Brazzi L, Pelosi P et al (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 333:1025–1032

    Article  CAS  PubMed  Google Scholar 

  20. Gore DC, Wolfe RR (2006) Hemodynamic and metabolic effects of selective beta1 adrenergic blockade during sepsis. Surgery 139:686–694

    Article  PubMed  Google Scholar 

  21. Berk JL, Hagen JF, Dunn JM (1970) The role of beta adrenergic blockade in the treatment of septic shock. Surg Gynecol Obstet 130:1025–1034

    CAS  PubMed  Google Scholar 

  22. Schmittinger CA, Dunser MW, Haller M et al (2008) Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depression. Crit Care 12:R99

    Article  PubMed Central  PubMed  Google Scholar 

  23. Macchia A, Romero M, Comignani PD et al (2012) Previous prescription of beta-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis. Crit Care Med 40:2768–2772

    Article  PubMed  Google Scholar 

  24. Orbegozo CD, Njimi H, Dell’Anna AM, Taccone FS (2014) Esmolol for septic shock: more than just heart rate control? Minerva Anestesiol 80:254–258

    Google Scholar 

  25. Shaw JH, Holdaway CM, Humberstone DA (1998) Metabolic intervention in surgical patients: the effect of alpha- or beta-blockade on glucose and protein metabolism in surgical patients receiving total parenteral nutrition. Surgery 103:520–525

    Google Scholar 

  26. Dinarello CA, Abraham E (2002) Does blocking cytokines in sepsis work? Am J Respir Crit Care Med 166:1156–1157

    Article  PubMed  Google Scholar 

  27. Oberbeck R, van Griensven M, Nickel E, Tschernig T, Wittwer T, Pape HC (2002) Influence of beta-adrenoceptor antagonists on hemorrhage-induced cellular immune suppression. Shock 18:331–335

    Article  PubMed  Google Scholar 

  28. Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349

    Article  CAS  PubMed  Google Scholar 

  29. Noveanu M, Breidthardt T, Reichlin T et al (2010) Effect of oral beta-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study. Crit Care 14:R198

    Article  PubMed Central  PubMed  Google Scholar 

  30. Au DH, Curtis JR, Every NR, McDonell MB, Fihn SD (2002) Association between inhaled beta-agonists and the risk of unstable angina and myocardial infarction. Chest 121:846–851

    Article  CAS  PubMed  Google Scholar 

  31. Albouaini K, Andron M, Alahmar A, Egred M (2007) Beta-blockers use in patients with chronic obstructive pulmonary disease and concomitant cardiovascular conditions. Int J Chron Obstruct Pulmon Dis 2:535–540

    PubMed Central  PubMed  Google Scholar 

  32. Salpeter SR, Ormiston TM, Salpeter EE, Poole PJ, Cates CJ (2003) Cardioselective beta-blockers for chronic obstructive pulmonary disease: a meta-analysis. Respir Med 97:1094–1101

    Article  CAS  PubMed  Google Scholar 

  33. van der Woude HJ, Zaagsma J, Postma DS, Winter TH, van Huist M, Aalbers R (2005) Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers. Chest 127:818–824

    Article  PubMed  Google Scholar 

  34. van der Jagt M, van der Miranda DR (2012) Beta-blockers in intensive care medicine: potential benefit in acute brain injury and acute respiratory distress syndrome. Recent Pat Cardiovasc Drug Discov 7:141–151

    Article  PubMed  Google Scholar 

  35. Kargin F, Takir HB, Salturk C et al (2014) The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit. Multidiscip Respir Med 9:8

    Article  PubMed Central  PubMed  Google Scholar 

  36. Hagiwara S, Iwasaka H, Maeda H, Noguchi T (2009) Landiolol, an ultrashort-acting beta1-adrenoceptor antagonist, has protective effects in an LPS-induced systemic inflammation model. Shock 31:515–520

    Article  CAS  PubMed  Google Scholar 

  37. Aboab J, Sebille V, Jourdain M et al (2011) Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shock. Intensive Care Med 37:1344–1351

    Article  CAS  PubMed  Google Scholar 

  38. Woolf PD, Hamill RW, Lee LA, Cox C, McDonald JV (1987) The predictive value of catecholamines in assessing outcome in traumatic brain injury. J Neurosurg 66:875–882

    Article  CAS  PubMed  Google Scholar 

  39. Goldstein B, Toweill D, Lai S, Sonnenthal K, Kimberly B (1998) Uncoupling of the autonomic and cardiovascular systems in acute brain injury. Am J Physiol 275:R1287–R1292

    CAS  PubMed  Google Scholar 

  40. Hortnagl H, Hammerle AF, Hackl JM, Brucke T, Rumpl E, Hortnagl H (1980) The activity of the sympathetic nervous system following severe head injury. Intensive Care Med 6:169–170

    Article  CAS  PubMed  Google Scholar 

  41. Bruder N, Rabinstein A (2011) Cardiovascular and pulmonary complications of aneurysmal subarachnoid hemorrhage. Neurocrit Care 15:257–269

    Article  PubMed  Google Scholar 

  42. Inaba K, Teixeira PG, David JS et al (2008) Beta-blockers in isolated blunt head injury. J Am Coll Surg 206:432–438

    Article  PubMed  Google Scholar 

  43. Ker K, Perel P, Blackhall K (2009) Beta-2 receptor antagonists for traumatic brain injury: a systematic review of controlled trials in animal models. CNS Neurosci Ther 15:52–64

    Article  CAS  PubMed  Google Scholar 

  44. Greendyke RM, Kanter DR, Schuster DB, Verstreate S, Wootton J (1986) Propranolol treatment of assaultive patients with organic brain disease. A double-blind crossover, placebo-controlled study. J Nerv Ment Dis 174:290–294

    Article  CAS  PubMed  Google Scholar 

  45. Feibel JH, Baldwin CA, Joynt RJ (1981) Catecholamine-associated refractory hypertension following acute intracranial hemorrhage: control with propranolol. Ann Neurol :340–343

    Google Scholar 

  46. Cotton BA, Snodgrass KB, Fleming SB et al (2007) Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma 62:26–33

    Article  CAS  PubMed  Google Scholar 

  47. Arbabi S, Campion EM, Hemmila MR et al (2007) Beta-blocker use is associated with improved outcomes in adult trauma patients. J Trauma 62:56–61

    Article  CAS  PubMed  Google Scholar 

  48. Riordan WP Jr., Cotton BA, Norris PR, Waitman LR, Jenkins JM, Morris JA Jr (2007) Beta-blocker exposure in patients with severe traumatic brain injury (TBI) and cardiac uncoupling. J Trauma 63:503–510

    Article  CAS  PubMed  Google Scholar 

  49. Schroeppel TJ, Fischer PE, Zarzaur BL et al (2010) Beta-adrenergic blockade and traumatic brain injury: protective? J Trauma 69:776–782

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan University, Milan, Italy

    S. Coppola, S. Froio & D. Chiumello

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  2. S. Froio
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  3. D. Chiumello
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Correspondence to D. Chiumello .

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  1. Université libre de Bruxelles, Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent Prof.

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Coppola, S., Froio, S., Chiumello, D. (2015). β-Blockers in Critically Ill Patients: From Physiology to Clinical Evidence. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_11

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  • DOI: https://doi.org/10.1007/978-3-319-13761-2_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13760-5

  • Online ISBN: 978-3-319-13761-2

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