Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study
Abstract Background Several studies have shown that heart rate control with selective beta-1 blockers in septic shock is safe. In these trials, esmolol was administered 24 h after onset of septic shock in patients who remained tachycardic. While an earlier use of beta-blockers might be beneficial, s...
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doaj-e80288abed09485696c89065ee0a20f32021-01-10T12:29:45ZengBMCCritical Care1364-85352021-01-012511910.1186/s13054-020-03445-wHemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot studyBruno Levy0Caroline Fritz1Caroline Piona2Kevin Duarte3Andrea Morelli4Philippe Guerci5Antoine Kimmoun6Nicolas Girerd7Service de Médecine Intensive Et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-ChirurgicalService de Médecine Intensive Et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-ChirurgicalService de Médecine Intensive Et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-ChirurgicalINSERM CIC1433, Nancy University HospitalINSERM CIC1433, Nancy University HospitalDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of NancyService de Médecine Intensive Et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-ChirurgicalINSERM CIC1433, Nancy University HospitalAbstract Background Several studies have shown that heart rate control with selective beta-1 blockers in septic shock is safe. In these trials, esmolol was administered 24 h after onset of septic shock in patients who remained tachycardic. While an earlier use of beta-blockers might be beneficial, such use remains challenging due to the difficulty in distinguishing between compensatory and non-compensatory tachycardia. Therefore, the Esmosepsis study was designed to study the effects of esmolol aimed at reducing the heart rate by 20% after the initial resuscitation process in hyperkinetic septic shock patients on (1) cardiac index and (2) systemic and regional hemodynamics as well as inflammatory patterns. Methods Nine consecutive stabilized tachycardic hyperkinetic septic shock patients treated with norepinephrine for a minimum of 6 h were included. Esmolol was infused during 6 h in order to decrease the heart rate by 20%. The following data were recorded at hours H0 (before esmolol administration), H1–H6 (esmolol administration) and 1 h after esmolol cessation (H7): systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, central venous pressure, heart rate, PICCO transpulmonary thermodilution, sublingual and musculo-cutaneous microcirculation, indocyanine green clearance and echocardiographic parameters, diuresis, lactate, and arterial and venous blood gases. Results Esmolol was infused 9 (6.4–11.6) hours after norepinephrine introduction. Esmolol was ceased early in 3 out of 9 patients due to a marked increase in norepinephrine requirement associated with a picture of persistent cardiac failure at the lowest esmolol dose. For the global group, during esmolol infusion, norepinephrine infusion increased from 0.49 (0.34–0.83) to 0.78 (0.3–1.11) µg/min/kg. The use of esmolol was associated with a significant decrease in heart rate from 115 (110–125) to 100 (92–103) beats/min and a decrease in cardiac index from 4.2 (3.1–4.4) to 2.9 (2.5–3.7) l/min/m−2. Indexed stroke volume remained unchanged. Cardiac function index and global ejection fraction also markedly decreased. Using echocardiography, systolic, diastolic as well as left and right ventricular function parameters worsened. After esmolol cessation, all parameters returned to baseline values. Lactate and microcirculatory parameters did not change while the majority of pro-inflammatory proteins decreased in all patients. Conclusion In the very early phase of septic shock, heart rate reduction using fast esmolol titration is associated with an increased risk of hypotension and decreased cardiac index despite maintained adequate tissue perfusion (NCT02068287).https://doi.org/10.1186/s13054-020-03445-wSeptic shockInflammationNorepinephrineBeta-blockers |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bruno Levy Caroline Fritz Caroline Piona Kevin Duarte Andrea Morelli Philippe Guerci Antoine Kimmoun Nicolas Girerd |
spellingShingle |
Bruno Levy Caroline Fritz Caroline Piona Kevin Duarte Andrea Morelli Philippe Guerci Antoine Kimmoun Nicolas Girerd Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study Critical Care Septic shock Inflammation Norepinephrine Beta-blockers |
author_facet |
Bruno Levy Caroline Fritz Caroline Piona Kevin Duarte Andrea Morelli Philippe Guerci Antoine Kimmoun Nicolas Girerd |
author_sort |
Bruno Levy |
title |
Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study |
title_short |
Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study |
title_full |
Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study |
title_fullStr |
Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study |
title_full_unstemmed |
Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study |
title_sort |
hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2021-01-01 |
description |
Abstract Background Several studies have shown that heart rate control with selective beta-1 blockers in septic shock is safe. In these trials, esmolol was administered 24 h after onset of septic shock in patients who remained tachycardic. While an earlier use of beta-blockers might be beneficial, such use remains challenging due to the difficulty in distinguishing between compensatory and non-compensatory tachycardia. Therefore, the Esmosepsis study was designed to study the effects of esmolol aimed at reducing the heart rate by 20% after the initial resuscitation process in hyperkinetic septic shock patients on (1) cardiac index and (2) systemic and regional hemodynamics as well as inflammatory patterns. Methods Nine consecutive stabilized tachycardic hyperkinetic septic shock patients treated with norepinephrine for a minimum of 6 h were included. Esmolol was infused during 6 h in order to decrease the heart rate by 20%. The following data were recorded at hours H0 (before esmolol administration), H1–H6 (esmolol administration) and 1 h after esmolol cessation (H7): systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, central venous pressure, heart rate, PICCO transpulmonary thermodilution, sublingual and musculo-cutaneous microcirculation, indocyanine green clearance and echocardiographic parameters, diuresis, lactate, and arterial and venous blood gases. Results Esmolol was infused 9 (6.4–11.6) hours after norepinephrine introduction. Esmolol was ceased early in 3 out of 9 patients due to a marked increase in norepinephrine requirement associated with a picture of persistent cardiac failure at the lowest esmolol dose. For the global group, during esmolol infusion, norepinephrine infusion increased from 0.49 (0.34–0.83) to 0.78 (0.3–1.11) µg/min/kg. The use of esmolol was associated with a significant decrease in heart rate from 115 (110–125) to 100 (92–103) beats/min and a decrease in cardiac index from 4.2 (3.1–4.4) to 2.9 (2.5–3.7) l/min/m−2. Indexed stroke volume remained unchanged. Cardiac function index and global ejection fraction also markedly decreased. Using echocardiography, systolic, diastolic as well as left and right ventricular function parameters worsened. After esmolol cessation, all parameters returned to baseline values. Lactate and microcirculatory parameters did not change while the majority of pro-inflammatory proteins decreased in all patients. Conclusion In the very early phase of septic shock, heart rate reduction using fast esmolol titration is associated with an increased risk of hypotension and decreased cardiac index despite maintained adequate tissue perfusion (NCT02068287). |
topic |
Septic shock Inflammation Norepinephrine Beta-blockers |
url |
https://doi.org/10.1186/s13054-020-03445-w |
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