Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation
This systematic review and meta-analysis examined the use of ultrashort-acting β-blockers (esmolol and landiolol) in patients with sepsis and septic shock and persistent tachycardia despite initial resuscitation. Seven randomized controlled trials with 613 patients were analyzed. The results showed that using esmolol or landiolol was associated with significantly lower 28-day mortality (RR: 0.68, 95% CI: 0.54-0.85, P < .001). The absolute risk reduction was 0.18, and the number needed to treat to prevent one death was 5.5.
The meta-analysis reported that ultrashort-acting β1-blockers can increase stroke volume index and reduce heart rate without changing the cardiac index, mean arterial pressure, or norepinephrine requirement at 24 hours. This suggests that these drugs can improve cardiovascular efficiency in septic patients and may improve mortality outcomes in such patients. However, the exact mechanisms behind these effects and their implications for patient outcomes need to be further explored.
I thin cL the main mechanism behind stroke volume and cardiac index improvement and mortality improvement is the control of HR that allows better LV filling and increases the SV and COP and also optimise the diastolic time and myocardial perfusion
we know from the HR SV curve that the cardiac output significantly reduced with HR more than 120/min as well as myocardial perfusion