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

Abstract

Betablockade has been shown to have cardioprotective effects in patients under perioperative stress. Besides animal model of septic shock and a small cohort of septic patients, these benefits have not been studied in septic shock patients who require norepinephrine administration. After correction of preload, an esmolol bolus (0.2-0.5mg/kg) followed by continuous 24h infusion was administered in septic patients with sinus or supraventricular tachycardia (HR > 120/min). Exclusion criteria were severe LV systolic dysfunction, atrioventricular blockade and norepinephrine infusion at rates over 0.5mg/kg/min. Monitoring with echocardiography and pulmonary artery catheter before, at 2, 6, 12, 24h following the start and 6h after ceasing of the esmolol drip. Patients were maintained normovolemic throughout the study and adjustments of concomitant norepinephrine infusion rates were made as required. Ten septic patients (mean age 54.4 ± 18.7), APACHE II 21.5 ± 6.2, CRP 275 ± 78mg/l, procalcitonin 14.5 ± 10.1mg/l, were given esmolol drip of 212.5 ± 63.5mg/h at start to 272.5 ± 89.5mg/h at 24h. Heart rate decreased from mean 142 ± 11/min to 112 ± 9/min (p < 0.001) with parallel insignificant reduction of cardiac index (4.94 ± 0.76 to 4.35 ± 0.72l/min/m(2)). Stroke volume insignificantly increased from 67.1 ± 16.3ml to 72.9 ± 15.3ml. No parallel change of pulmonary artery wedge pressure was observed (15.9 ± 3.2 to 15.0 ± 2.4mmHg) as well as no significant changes of norepinephrine infusion (0.13 ± 0.17 to 0.17 ± 0.19mg/kg/min), DO(2), VO(2), OER or arterial lactate. Saving the heart 30beats/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.