Ventilator-associated Pneumonia Research Articles

Oral hygiene for severe care: a literature review

The efficacy and quality of oral hygiene are currently a major concern, especially in intensive care patients. This literature review assessed the available data on oral hygiene in intensive care patients using various antiseptics, as well as the methods of their use. The literature search was performed using databases Scopus, PubMed, Web of Science, eLIBRARY.RU, and Google Scholar. Original peer-reviewed research on the clinical efficacy of oral care published between 2000 and 2023 were analyzed. The studies assessed the efficacy of hydrogen peroxide (n=2, 10%), chlorhexidine (n=10, 50%), Povidone-Iodine (n=2, 10%), and herbal formulations (n=4, 20%). According to the majority of studies, oral hygiene in intensive care patients reduces the incidence of ventilator-associated pneumonia, but has no effect on the duration of artificial ventilation or the mortality rate. The study discovered the absence of a universal, effective protocol for oral hygiene in intensive care patients, as well as guidelines for the selection of antiseptics, their concentration, and application methods. This subject necessitates further research.

Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review

Pneumonia remains a major global health concern, causing significant morbidity and mortality among adults. This narrative review assesses the optimal duration of antimicrobial treatment in adults with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Current evidence about the impact of treatment duration on clinical outcomes demonstrates that shorter antibiotic courses are non-inferior, regarding safety and efficacy, compared to longer courses, particularly in patients with mild to moderate CAP, which is in line with the recommendations of international guidelines. Data are limited regarding the optimal antimicrobial duration in HAP patients, and it should be individually tailored to each patient, taking into account the causative pathogen and the clinical response. Shorter courses are found to be as effective as longer courses in the management of VAP, except for pneumonia caused by non-fermenting Gram-negative bacteria; however, duration should be balanced between the possibility of higher recurrence rates and the documented benefits with shorter courses. Additionally, the validation of reliable biomarkers or clinical predictors that identify patients who would benefit from shorter therapy is crucial. Insights from this review may lead to future research on personalized antimicrobial therapies in pneumonia, in order to improve patient outcomes.

Legionella pneumophila—Klebsiella pneumoniae Pulmonary Coinfection in a COVID-19 Patient: Case Report

Background. Pulmonary superinfections increase the mortality risk among COVID-19 patients, highlighting the need for enhanced understanding to enable early and accurate diagnosis. Methods. We present the case of a patient, a 76-year-old man, hospitalized for a severe form of COVID-19, with a ground-glass pneumonia, involving 40–45% of lung surfaces. Results. In evolution, the clinical condition worsened, presenting leukocytosis with neutrophilia, imaging towards resorption, and computer tomography images showing the appearance of pulmonary condensations in the right lower lobe, the posterior portion of the left lower lobe and pleural collections. Carbapenemase-producing Klebsiella pneumoniae was isolated from the tracheal aspirate, and the real-time polymerase chain reaction test was positive for Klebsiella pneumoniae and Legionella pneumophila. The investigations that were carried out allowed us to establish the coinfections as a probable case of Legionnaire’s disease and a ventilator-associated pneumonia with Klebsiella pneumoniae. Conclusions. The case analysis revealed that rare pneumonias may remain undiagnosed, and coinfections may be conditioned by pathophysiological factors or components of COVID-19 critical form treatment. Enhanced understanding of these aspects in clinical practice may contribute to reducing mortality risk in COVID-19 patients.

Identifying the Bundle/Care Development Process in Clinical Risk Management: A Systematic Review

Background: A bundle is a set of three to five evidence-based interventions designed to improve the quality and outcomes of care processes. Numerous international studies have evaluated the effectiveness of Bundles/Care Bundles (BCB) in reducing morbidity and mortality. The Institute for Healthcare Improvement (IHI) has defined the concept of a bundle but has not outlined the development process. Objective: To identify the BCB development process in clinical risk scenarios from September 2005 to September 2023. Methods: A systematic review was conducted following PRISMA guidelines to identify studies describing the BCB development process in managing clinical risk situations. The databases consulted included PubMed, Embase, and CINAHL, along with manual searches on institutional websites. Relevant studies concerning the BCB development process were included. Results: A total of 1372 studies were retrieved, of which 16 were included. Duplicates were removed, and titles and abstracts were analyzed. The identified methods for BCB development include IHI guidelines, expert opinions, international guidelines, and flowcharts. The most common BCBs relate to the prevention of ventilator-associated pneumonia, surgical site infections, catheter-associated infections, and sepsis. Conclusions: This study has identified the development processes of Care Bundles (BCBs) in clinical risk scenarios, highlighting how these tools facilitate compliance monitoring among members of the healthcare team. The review has revealed effective methods for designing evidence-based BCBs. However, the scarcity of studies on the methodology for developing BCBs is a limitation, suggesting the need for further research. In Italy, there is a growing interest in the use of care packages. It is essential to encourage research that optimizes the effectiveness of intervention strategies.

The Use of Trendelenburg Position in the Management of Retropharyngeal Abscess: A Case Report and Clinical Considerations

Background: Retropharyngeal abscess (RPA) is a serious deep neck space infection that can lead to life-threatening complications such as airway obstruction, mediastinitis, and sepsis. The Trendelenburg position, where the patient's head is lower than their feet, has been traditionally used in the management of RPA to prevent aspiration of pus in case of abscess rupture. However, the optimal positioning for patients with RPA remains a topic of debate. Case presentation: A 51-year-old male patient presented to the emergency room with a 5-day history of progressive dysphagia and neck swelling. He was diagnosed with a ruptured retropharyngeal abscess extending to the mediastinum (descending necrotizing mediastinitis). The patient underwent surgical drainage and was subsequently admitted to the intensive care unit (ICU), where he was intubated and mechanically ventilated in the Trendelenburg position. Five days later, the patient developed pneumonia, suspected to be ventilator-associated pneumonia (VAP). Conclusion: The Trendelenburg position may be considered in the management of RPA to minimize the risk of aspiration. However, it is essential to weigh the potential benefits against the risks, including VAP, and to consider alternative positions such as the lateral Trendelenburg position, which may offer similar benefits with reduced risk. Further research is needed to determine the optimal positioning strategy for patients with RPA.

The impact of the Centers for Disease Control and Prevention new surveillance definitions of ventilator-associated event on our clinical practice

ABSTRACT Objective Surveillance of ventilator-associated pneumonia is subjective, inaccurate, time-consuming, and does not predict outcomes. The Centers for Disease Control and Prevention (CDC) recommended the use of ventilator-associated event (VAE) definitions instead of ventilator-associated pneumonia (VAP) in 2013. Therefore, we evaluated this novel surveillance algorithm by comparing the results of our VAP and VAE methods. Material Methods We evaluated mechanically ventilated adult medical and surgical patients in our 13-bed intensive care unit (ICU). Nine patients diagnosed with VAP in 2018-2019 and 11 patients diagnosed with VAE in 2022-2024 were retrospectively evaluated. The impact of the new definitions on clinical processes such as days on the mechanical ventilator, duration of antibiotic use, ICU stay in determining infectious status was monitored. Results. Statistical analysis revealed that demographic and numeric data were similar in both VAP and VAE diagnosis groups (p

Epidemiology, clinical and biological characteristics, and prognosis of critically ill COVID 19 patients: a single-center experience through 4 successive waves

ObjectiveThe aim of this study was to describe the characteristics of patients admitted to the intensive care unit with severe pneumonia due to SARS-CoV-2, comparing them according to successive waves, and to identify prognostic factors for morbidity and mortality.Materials and methodsThis single-center retrospective observational descriptive study was conducted from March 10, 2020, to October 17, 2021. All adult patients admitted with SARS-CoV-2 pneumonia presenting acute respiratory failure were included. COVID 19 diagnosis was confirmed by RT-PCR testing of respiratory specimens. The primary endpoint was ICU mortality. Secondary endpoints were the occurrence of ventilator-associated pneumonia (VAP) or bronchopulmonary aspergillosis.ResultsOver the study period, 437 patients were included of whom 282 (65%) patients were ventilated for 9 [5;20] days. Among the studied population, 38% were treated for one or more episodes of VAP, and 22 (5%) for bronchopulmonary aspergillosis. ICU mortality was 26% in the first wave, then fell and stabilized at around 10% in subsequent waves (p = 0.02). Increased age, Charlson index, SOFA score and lactatemia on admission were predictive of mortality. Survival at 90 days was 85% (95% CI 82–88) and was unaffected by the presence of VAP. However, the occurrence of bronchopulmonary aspergillosis increased mortality to 36%.ConclusionIn this study, we observed mortality in the lower range of those previously reported. Risk factors for mortality mainly included age and previous comorbidities. The prognosis of these critically ill Covid 19 patients improved over the four waves, underlining the likely beneficial effect of vaccination and dexamethasone.

ASSESSMENT OF KNOWLEDGE REGARDING EVIDENCE BASED GUIDELINES ON VAP PREVENTION AMONG NURSES

Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that increases morbidity, mortality, and healthcare costs, particularly in intensive care units (ICUs). In Pakistan, the high prevalence of VAP in ICUs underscores the importance of adherence to evidence-based preventive practices among nursing staff. However, knowledge gaps and inconsistencies in VAP preventive practices remain a challenge, largely due to limited training resources and high patient-to-nurse ratios. Objective: This study aimed to assess the knowledge of ICU nurses on evidence-based guidelines for VAP prevention at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study design was utilized. Data were collected from 140 registered nurses working in the ICU of Sir Ganga Ram Hospital, Lahore, using a structured questionnaire consisting of 17 questions related to VAP prevention guidelines. Convenience sampling was employed to recruit participants who met the inclusion criteria. Data analysis was performed using SPSS, with descriptive statistics applied to summarize findings and identify knowledge gaps. Results: The study revealed varied levels of knowledge among ICU nurses regarding VAP prevention. While the majority demonstrated awareness of core practices, such as semi-recumbent positioning and regular oral care, there were notable gaps in understanding related to the frequency of ventilator circuit changes and the optimal use of suction systems. Approximately 67.9% of nurses were aware of general VAP guidelines, but only 47.1% correctly identified all recommended practices. Additionally, knowledge disparities were observed based on educational background and years of ICU experience.Conclusion: This study highlights critical knowledge gaps among ICU nurses regarding evidence-based VAP prevention practices. The findings underscore the need for targeted educational interventions and standardized training programs to improve adherence to VAP guidelines. Strengthening nurse education on VAP prevention can contribute to reduced infection rates, enhanced patient safety, and better utilization of healthcare resources in Pakistan’s ICUs.

‘Effectiveness of various sulbactam-based combination antibiotic therapy in the management of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in a tertiary care Health centre’

ObjectiveCarbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB. MethodsAdult patients (age ≥18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies. ResultsA total of 103 patients were included. A total of 44 (42.7 %) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3 %) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51 % (95 % CI 8.03 %–44.06 %; p = 0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65 % (95 % CI 6.43 %–38.3 %; p = 0.007) and 25.1 % (95%CI 10.1 %–38.2 %; p < 0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy. ConclusionTreatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.

Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial

The REGARD-VAP trial showed that individualised shortened antibiotic therapy was non-inferior to usual care for mortality and pneumonia recurrence in patients with ventilator-associated pneumonia (VAP). We aimed to assess the cost-effectiveness of an individualised shortened antibiotic therapy approach in this planned economic analysis. REGARD-VAP was a phase 4, multicentre, open-label, randomised trial to assess a short-course antibiotic treatment strategy for treatment of VAP. In this planned economic analysis, we fitted a decision tree with data from the REGARD-VAP trial to estimate the cost-effectiveness of individualised short-course therapy for VAP, compared to usual care from the health system perspective, in Nepal, Singapore, and Thailand. Incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits with 95% uncertainty intervals (UIs) were reported against relevant willingness-to-pay thresholds. Parameter uncertainties were evaluated using scenario analyses. A value of information analysis was conducted. Adopting individualised short-course therapy was cost-effective for Nepal (ICER=US$1086; percentage cost-effectiveness=50·3%), Singapore (ICER=-$6069; percentage cost-effectiveness=55·2%), and Thailand (ICER=$263; percentage cost-effectiveness=60·5%). The associated incremental net monetary benefits were $41 (95% UI -2308 to 2390) in Nepal, $5156 (-45 805 to 56 117) in Singapore, and $804 (-6245 to 7852) in Thailand. Value of information analysis showed that reducing uncertainties for mortality probabilities, bed-day costs, and variable costs were valuable for decision making. We found that an individualised short-course antibiotics strategy in patients with VAP is likely to be cost-effective in high-income, middle-income, and low-income settings, although with evident uncertainty. Considered alongside the positive externalities of reduced antimicrobial use, our findings foster confidence in policy makers contemplating adoption of short-course antibiotics. UK Medical Research Council, Singapore National Medical Research Council, and Wellcome Trust.

The Effects of Prophylactic Laxative Use on Critically Ill Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study

Objective: To investigate the effects of prophylactic use of stimulant laxatives and/or docusate on the clinical outcomes in critically ill patients who required mechanical ventilation (MV). Methods: A single-center, retrospective, cohort study was conducted. Patients who received MV in the first 24 h after intensive care unit (ICU) admission were enrolled and divided into four groups: non-laxative, stimulant laxatives, docusate, and stimulant laxatives–docusate combination. The primary outcome was in-hospital mortality. The major secondary outcomes included ICU-free days and ventilator-free days at 28 days; the other outcomes were ventilation-associated pneumonia (VAP), enterobacterial infection, diarrhea, and electrolyte disturbances. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. Results: A total of 2129 patients were included in this study, 263 of whom received stimulant laxatives, 253 received docusate, 368 received a combination, and 1245 did not receive any laxative. The prophylactic use of docusate was associated with a decreased risk of in-hospital mortality (OR: 0.59, 95% CI 0.42 to 0.83, p = 0.002) and VAP (OR: 0.62, 95% CI 0.47 to 0.81, p = 0.001). It was also associated with an increase in ICU-free days at 28 days (β: 0.89, 95% CI 0.83 to 0.95, p &lt; 0.001). Importantly, laxatives prophylaxis was not associated with increased risks of diarrhea, electrolyte disturbances, and enterobacterial infections. Conclusions: Prophylactic use of docusate may improve certain prognoses and does not demonstrate any adverse events. However, further research is necessary to determine the optimal regimen and dosage of prophylactic laxatives in this specific population.

PP150 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: VENTILATOR-ASSOCIATED PNEUMONIAS: INCIDENCE AND MICROBIOLOGICAL PROFILE IN A TUNISIAN PEDIATRIC INTENSIVE CARE UNIT

PP150 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: VENTILATOR-ASSOCIATED PNEUMONIAS: INCIDENCE AND MICROBIOLOGICAL PROFILE IN A TUNISIAN PEDIATRIC INTENSIVE CARE UNIT

Prediction Model, Risk Factor Score and Ventilator-associated Pneumonia: a two-stage Case-control Study

Prediction Model, Risk Factor Score and Ventilator-associated Pneumonia: a two-stage Case-control Study

Flexible Development Programs for Antibacterial Drugs to Address Unmet Medical Needs.

The US Food and Drug Administration recognizes the unmet medical need for antibacterial drugs to treat serious bacterial diseases caused by resistant pathogens for which effective therapies are limited or lacking. The agency also recognizes that designing and conducting clinical trials to assess the safety and efficacy of drugs to treat resistant infections is challenging, especially for drugs only active against a single or a few bacterial species, and that a more flexible development program might be appropriate. In this article, we discuss several regulatory considerations for flexible development programs for antibacterial drugs intended to meet an unmet medical need. As an example, we use the recent approval of sulbactam for injection and durlobactam for injection (XACDURO) for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia caused by susceptible isolates of Acinetobacter baumannii-calcoaceticus complex.

EVALUATION OF THE ROLE OF SELECTIVE DIGESTIVE TRACT DECONTAMINATION IN PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT PATIENTS

Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in critically ill patients, contributing to increased morbidity, mortality, and healthcare costs. The incidence of VAP in intensive care units (ICUs) ranges from 7% to 40%, with mortality rates potentially exceeding 50%1. Recent studies highlight that VAP affects approximately 27% of all critically ill patients, with 86% of these infections associated with mechanical ventilation. The attributable mortality of VAP varies, with some studies reporting an increase in mortality of up to 27%3. Pathogens such as Pseudomonas aeruginosa, Acinetobacter, and Stenotrophomonas maltophilia are linked to higher mortality rates4. Beyond mortality, VAP significantly extends ICU length of stay and increases healthcare costs5. The gastrointestinal tract plays a crucial role in VAP pathogenesis, as it often becomes colonized with Gram-negative bacteria during critical illness6. Interventions such as selective decontamination of the digestive tract (SDD), stress ulcer prophylaxis with sucralfate, and enteral feeding strategies are employed to reduce VAP incidence. While SDD has been shown to decrease VAP incidence and may positively impact mortality, it also poses a risk of promoting Gram-positive bacterial infections. SDD involves the use of non-absorbable antibiotics applied topically to the oropharynx and through a nasogastric tube, often supplemented with systemic antibiotics during the initial days of ICU admission. Recent guidelines and systematic reviews continue to emphasize the importance of accurate VAP diagnosis and effective antimicrobial therapy to improve patient outcomes and reduce healthcare burdens.

Lung Ultrasound Score as a Predictor of Clinical Severity and Prognosis in Patients of Ventilator-associated Pneumonia

Lung Ultrasound Score as a Predictor of Clinical Severity and Prognosis in Patients of Ventilator-associated Pneumonia

Preventing ventilator-associated pneumonia non-pharmacologically.

Preventing ventilator-associated pneumonia non-pharmacologically.

Multifaceted Control Interventions for Healthcare-associated Infections in a Kidney Transplant Intensive Care Unit: Clinical Outcome Improvement and Bundle Adherence.

Healthcare-associated infections (HAIs) are preventable complications that overwhelm the healthcare system. The implementation of multifaceted control intervention actions in the intensive care setting modifies clinical outcomes, but its effectiveness has not been specifically investigated for high-risk patients, such as kidney transplant recipients (KTRs). This observational retrospective natural experiment evaluated the effectiveness of multifaceted control interventions (bundles) in reducing HAIs in a KTR intensive care unit. We also measured the bundle adherence rate during 16 mo in the after era. We included 1257 KTRs, 684 before and 573 in the postintervention period. After the bundle implementation, the incidence density of device-associated HAIs decreased from 8.5 to 3.9 per 1000 patient-days (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.25-0.85; P = 0.01), primarily because of the reduction in central line-associated bloodstream infection from 8.0 to 3.4 events per 1000 catheter-days (RR = 0.43; 95% CI, 0.22-0.83; P = 0.012). Reductions in catheter-associated urinary tract infection (2.5 versus 0.6 per 1000 catheter-days; RR = 0.22; 95% CI, 0.03-1.92; P = 0.17) and ventilator-associated pneumonia (3.4 versus 1.0 per 1000 ventilator-days; RR = 0.29; 95% CI, 0.03-2.63; P = 0.27) were not significant. Central venous (P = 0.53) and urinary catheter (P = 0.47) insertion adherence were stable during 16 mo, whereas central venous (P < 0.001) and urinary catheter (P = 0.004) maintenance gradually increased. Finally, ventilator-associated pneumonia prevention bundle adherence slightly decreased over time (P = 0.06). The implementation of comprehensive multifaceted control intervention actions in an intensive care unit dedicated to KTR care was effective in significantly reducing device-associated infections. The impact was in line with the reductions observed in populations that have not undergone transplantation, underscoring the effectiveness of these interventions across different patient groups.

Hand hygiene intervention in the prevention of healthcare associated infections

Abstract Background Healthcare associated infections are a major cause of morbidity and mortality in intensive care units. Observance hand hygiene is singled out as a key element in interruption of these infections. The present study aimed to assess whether hand hygiene intervention program in intensive care unit at the Sahloul University Hospital of Sousse is able to decrease healthcare associated infections. Methods We carried out a pre-experimental study among patients hospitalized in seven intensive care units at the Sahloul University Hospital of Sousse during two distinct periods of 3 months, the first in 2019 and the second in 2021. During these two periods, we monitored only patients hospitalized in the ICU for more than 48 hours and incidence of healthcare associated infections was compared. Healthcare associted infections were defined as infections occurred at least 48 hours after admission to the intensive care units. The hand hygiene promotion intervention, done during the year 2020, was based on 3 axes (training sessions, procedures writing and professional practicesevaluation). Results Incidence of healthcare associated infections decreased significantly in post-intervention (p = 0.000). The decrease of Ventilator-associated pneumonia was significantly higher than other types of infections(p = 0.042). Extended Spectrum B-Lactamase Producing Enterobacteriaceae infections and Ceftazidim resistant Pseudomonas Aeruginosa infections decreased significantly in after intervention (p = 0.000). Conclusions The results of our study showed that improved hand hygiene resulted in a reduction in healthcare associated infections. Key messages • Observance hand hygiene is singled out as a key element in interruption of healthcare associated infections. • Improved hand hygiene resulted in a reduction in healthcare associated infections.

The impact of intravenous metoprolol tartrate on mortality rates in patients with septic shock due to ventilator-associated pneumonia: A randomized clinical trial

Background: Septic shock, particularly due to ventilator-associated pneumonia (VAP), is a significant cause of mortality in critically ill patients. Traditional treatments include antimicrobial therapy, fluid resuscitation, and vasopressors. However, recent interest has emerged in using β-blockers to modulate the hyperadrenergic state seen in sepsis. β-blockers, like metoprolol, may improve cardiac efficiency, reduce myocardial oxygen demand, and ultimately enhance patient outcomes. Objective: This study aimed to assess the impact of administering intravenous metoprolol tartrate on the mortality rates of patients with septic shock due to VAP. Methods: This study employed a randomized clinical trial design within the Intensive Care Units of Alexandria Main University Hospital. A cohort of 100 patients diagnosed with septic shock due to ventilator-associated pneumonia (VAP) participated in the trial. Upon achieving hemodynamic stabilization, participants were randomly assigned to either receive standard care alone or standard care supplemented with intravenous metoprolol. Variables of interest included assessing 28-day mortality rates, duration of ICU stay and mechanical ventilation, reliance on intravenous fluids and vasopressors, acid-base balance, lactate levels, inflammatory markers, and mean arterial pressure (MAP). This comprehensive approach aimed to evaluate the impact of metoprolol on critical outcomes in this patient population. Results: The administration of intravenous metoprolol tartrate resulted in significant clinical benefits, including lower 28-day mortality rates (P = 0.013), shortened durations of ICU stay (P &lt; 0.001), and reduced mechanical ventilation periods (P &lt; 0.001). These outcomes were explained by the observed decreased reliance on intravenous fluids and vasopressors (P &lt; 0.001), improved acid-base balance and lactate levels. The rapid reduction of inflammatory markers (P &lt; 0.001) and the sustained improvement of MAP in the metoprolol group compared to the control group further contributed to the explication of these findings. Conclusion: Intravenous metoprolol tartrate effectively controlled inflammation, optimized hemodynamics, and improved patient outcomes compared to standard care, suggesting it as a beneficial adjunct in the management of septic shock. Trial registration: PACTR202404531355476. Keywords: Metoprolol; septic shock; ventilator-associated pneumonia; beta-blockers; mortality.