Safety and Efficacy of Ivabradine as a Rate Control for the Heart in Sepsis

Abstract

Abstract Background Sepsis and septic shock represent a major health problem among the critically ill patients all over the world, with associated substantial morbidity and mortality rates ranging from 18 % to 50 %. The incidence of sepsis has increased steadily over the last three decades, at least in part because of aging western population. Despite our increased understanding, improved support and more powerful antibiotic therapy, sepsis is still reported as the second leading cause of death in non-coronary intensive care units, and the tenth-mostcommon cause of death overall (the first being heart disease). Children under 12 months and elderly have the highest incidence of severe sepsis). Objective Evaluation of the role of heart rate control using enteral Ivabradine in the management of patients with sepsis. Assessment of the effect of enteral Ivabradine on outcome of septic patients regarding need for vasopressor therapy, mechanical ventilation, renal replacement therapy, length of ICU stay, in- hospital mortality and 30 days mortality. Patients and Methods The study was comparative prospective case / control study conducted on 60 critically ill patients admitted with sepsis and or septic shock to the Critical Care Department at Kobry Elkoba Military complex at 12 month from 8/2019 up to 8/ 2020. Results Significant decrease in follow up lactate at end of Ivabradine treatment, compared to control group without Ivabradine treatment (p = 0.025). Significant decrease in follow up of crp level in group A than group B at day 2 and day 4 with (p = 0.013), (p = 0.018) respectively. Significant decrease in heart rate in group A in comparison with group B during first 48 hour with (p = 0.008). Significant difference between group A and group B regarding weaning from mechanical ventilation with (p = 0.001). There was no statistically significant difference found between group A and group B regarding rate of mortality with p-value = 0.606. Conclusion Use of enteral Ivabradine can reduce pathologically elevated heart rate in patients with sepsis but didn‘t affect survival, length of ICU stay, between septic patient.