Role of enteral metoprolol tartrate on hemodynamics and clinical outcomes of septic shock patients of various pretargeted heart rate groups

Abstract

Introduction Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis’s course once it is infected. Objective The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups. Methods Septic shock patients (n=90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150 mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR = 60-70 beats/min), group B (HR = 71-80 beats/min), and group C (HR = 81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score. Results After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) (P < 0.001). After 3 days, group A had a significantly improved SvO2, lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements (P < 0.001) and shorter ICU stay (P = 0.001). Conclusion Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit.