Beta blockers improves survival in sepsis, septic shock with persistent tachycardia

Treatment with ultra-short-acting β-blockers, such as esmolol and landiolol, in sepsis and septic shock patients with persistent tachycardia leads to a significantly lower mortality at 28 days despite initial resuscitation, according to the results of a systematic review and meta-analysis.

Two independent reviewers assessed whether articles retrieved from multiple online databases met the following criteria: (1) randomized clinical trials, (2) patients with sepsis and septic shock aged ≥18 years, and (3) treatment with either esmolol/landiolol versus placebo/no interventions. Data were synthesized using random-effect models.

The meta-analysis included seven RCTs, with a total of 613 patients. Six of these trials involving 572 patients reported mortality at 28 days.

Pooled data showed that survival in patients with sepsis and septic shock improved significantly with either esmolol or landiolol. Use of the ultra-short-acting β-blockers was associated with a 32-percent reduction in 28-day mortality (risk ratio, 0.68, 95 percent confidence interval, 0.54–0.85; p<0.001).

There was unimportant heterogeneity observed among the studies (I², 31 percent).

The absolute risk reduction associated with esmolol or landiolol was 18.2 percent, and the number of patients needed to be treated with the ultra-short-acting β-blocker to prevent one death was 5.5.

Beta-blockers are relatively contraindicated for septic shock, because they may induce cardiac suppression. On the other hand, the interest in the use of the drugs for treating septic patients with persistent tachycardia has seen an increase. The present data suggest that esmolol and landiolol may improve survival in this population.