{"id":465,"date":"2025-01-23T10:29:19","date_gmt":"2025-01-23T10:29:19","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=465"},"modified":"2025-01-23T11:16:29","modified_gmt":"2025-01-23T11:16:29","slug":"mortality-in-septic-patients-treated-with-short-acting-betablockers-a-comprehensive-meta-analysis-of-randomized-controlled-trials","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2025\/01\/23\/mortality-in-septic-patients-treated-with-short-acting-betablockers-a-comprehensive-meta-analysis-of-randomized-controlled-trials\/","title":{"rendered":"Mortality in septic patients treated with short-acting betablockers: a comprehensive meta-analysis of randomized controlled trials"},"content":{"rendered":"

Abstract<\/h2>\n
\n

Background<\/h3>\n

Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.<\/p>\n

Methods<\/h3>\n

The data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm.<\/p>\n

Results<\/h3>\n

A total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, \u2212\u20090.10 [95% CI, \u2212\u20090.22 to 0.02];\u00a0p<\/i>\u2009=\u20090.11;\u00a0p<\/i>\u00a0for Cochran\u2019s Q test\u2009=\u20090.001; I2<\/sup>\u2009=\u200973%). No difference was seen when comparing patients aged\u2009<\u200965 versus\u2009\u2265\u200965\u00a0years (p<\/i>\u2009=\u20090.11) or sinus tachycardia with atrial fibrillation (p<\/i>\u2009=\u20090.27). Despite statistical heterogeneity, no significant publication bias was observed.<\/p>\n

Conclusion<\/h3>\n

Administration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.<\/p>\n

Key Points<\/strong>:<\/p><\/blockquote>\n

    \n
  1. Study Objective<\/strong>: Investigate whether short-acting beta-blockers improve mortality outcomes in septic patients with persistent tachycardia.<\/li>\n
  2. Included Trials<\/strong>: Seven RCTs, with patients randomized to beta-blockers (landiolol or esmolol) versus standard care or placebo.<\/li>\n
  3. Mortality Outcomes<\/strong>: No significant reduction in 28-day, 90-day, or hospital mortality was observed with beta-blockers.<\/li>\n
  4. Subgroup Analysis<\/strong>: Mortality outcomes did not differ based on patient age (<65 vs. \u226565 years) or initial cardiac rhythm (atrial fibrillation vs. sinus tachycardia).<\/li>\n
  5. Heart Rate Control<\/strong>: Beta-blockers achieved target heart rates (80\u201394 bpm), which could have other clinical benefits not captured by mortality endpoints.<\/li>\n
  6. Adverse Events<\/strong>: Serious adverse events, such as hypotension and bradycardia, were more common in beta-blocker groups, particularly with landiolol.<\/li>\n
  7. Statistical Heterogeneity<\/strong>: Significant variability between studies (I\u00b2 = 73%), suggesting differences in patient populations, methodologies, or treatment protocols.<\/li>\n
  8. Limitations<\/strong>: Lack of uniformity in hemodynamic monitoring and patient selection criteria across studies; open-label designs may introduce bias.<\/li>\n
  9. Future Directions<\/strong>: Emphasis on hemodynamic monitoring to identify patients likely to benefit from beta-blockers, and further investigation of esmolol and landiolol\u2019s comparative efficacy.<\/li>\n
  10. Clinical Implications<\/strong>: Beta-blocker use in septic patients should be approached cautiously, with consideration for individual hemodynamic status and potential adverse effects.<\/li>\n<\/ol>\n

    ACCESS FULL ARTICLE HERE<\/strong><\/a><\/p>\n

    Open Access<\/b>\u00a0This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit\u00a0http:\/\/creativecommons.org\/licenses\/by\/4.0\/<\/a>.<\/p>\n