The concomitant use of ultra short beta-blockers with vasopressors and inotropes in critically ill patients with septic shock: A systematic review and meta-analysis of randomized controlled trials

IF 3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Saudi Pharmaceutical Journal Pub Date : 2024-05-11 DOI:10.1016/j.jsps.2024.102094
Khalid Al Sulaiman , Hadeel A. Alkofide , Mashael E. AlFaifi , Sarah S. Aljohani , Abdullah F. Al Harthi , Rahaf A. Alqahtani , Ashwaq M. Alanazi , Lama H. Nazer , Abdulrahman I. Al Shaya , Ohoud Aljuhani
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Abstract

Background

Septic shock is associated with systemic inflammatory response, hemodynamic instability, impaired sympathetic control, and the development of multiorgan dysfunction that requires vasopressor or inotropic support. The regulation of immune function in sepsis is complex and varies over time. However, activating Beta-2 receptors and blocking Beta-1 receptors reduces the proinflammatory response by influencing cytokine production. Evidence that supports the concomitant use of ultra short beta-blockers with inotropes and vasopressors in patients with septic shock is still limited. This study aimed to evaluate the use of ultra short beta-blockers and its impact on the ICU related outcomes such as mortality, length of stay, heart rate control, shock resolution, and vasopressors/inotropes requirements.

Methods

A systematic review and meta-analysis of randomized controlled trials including critically ill patients with septic shock who received inotropes and vasopressors. Patients who received either epinephrine or norepinephrine without beta-blockers “control group” were compared to patients who received ultra short beta-blockers concomitantly with either epinephrine or norepinephrine “Intervention group”. MEDLINE and Embase databases were utilized to systematically search for studies investigating the use of ultra short beta-blockers in critically ill patients on either epinephrine or norepinephrine from inception to October 10, 2023. The primary outcome was the 28-day mortality. While, length of stay, heart rate control, and inotropes/ vasopressors requirements were considered secondary outcomes.

Results

Among 47 potentially relevant studies, nine were included in the analysis. The 28-day mortality risk was lower in patients with septic shock who used ultra short beta-blockers concomitantly with either epinephrine or norepinephrine compared with the control group (RR (95%CI): 0.69 (0.53, 0.89), I2=26%; P=0.24). In addition, heart rate was statistically significantly lower with a standardized mean difference (SMD) of -22.39 (95% CI: -24.71, –20.06) among the beta-blockers group than the control group. The SMD for hospital length of stay and the inotropes requirement were not statistically different between the two groups (SMD (95%CI): -0.57 (-2.77, 1.64), and SMD (95%CI): 0.08 (-0.02, 0.19), respectively).

Conclusion

The use of ultra short beta-blockers concomitantly with either epinephrine or norepinephrine in critically ill patients with septic shock was associated with better heart rate control and survival benefits without increment in the inotropes and vasopressors requirement.

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在脓毒性休克重症患者中同时使用β受体阻滞剂和血管加压/肌注药物:系统综述和荟萃分析
背景脓毒性休克与全身炎症反应、血液动力学不稳定、交感神经控制受损以及多器官功能障碍的发展有关,需要血管加压或肌力支持。脓毒症的免疫功能调节非常复杂,且随时间而变化。不过,激活 Beta-2 受体和阻断 Beta-1 受体可通过影响细胞因子的产生来减少促炎反应。支持在脓毒性休克患者中同时使用超短β-受体阻滞剂与肌注药和血管加压药的证据仍然有限。本研究旨在评估超短β-受体阻滞剂的使用及其对重症监护室相关结果的影响,如死亡率、住院时间、心率控制、休克缓解以及血管加压剂/肌注的需求。将接受肾上腺素或去甲肾上腺素治疗但不使用β-受体阻滞剂的 "对照组 "患者与同时接受超短β-受体阻滞剂和肾上腺素或去甲肾上腺素治疗的 "干预组 "患者进行比较。利用 MEDLINE 和 Embase 数据库,系统地搜索了从开始到 2023 年 10 月 10 日期间有关在使用肾上腺素或去甲肾上腺素的重症患者中使用超短β-受体阻滞剂的研究。主要结果是 28 天死亡率。结果 在 47 项可能相关的研究中,有 9 项被纳入分析。与对照组相比,同时使用超短β受体阻滞剂和肾上腺素或去甲肾上腺素的脓毒症休克患者 28 天内的死亡风险较低(RR (95%CI): 0.69 (0.53, 0.89), I2=26%; P=0.24)。此外,与对照组相比,β-受体阻滞剂组的心率明显降低,标准化平均差(SMD)为-22.39(95% CI:-24.71,-20.06)。两组间住院时间和肌注需求的 SMD 无统计学差异(SMD (95%CI): -0.57 (-2.77, 1.64) 和 SMD (95%CI): 0.08 (-0.02, 0.19))。结论脓毒性休克重症患者在使用超短β受体阻滞剂的同时使用肾上腺素或去甲肾上腺素能更好地控制心率,并在不增加肌力药和血管加压药需求的情况下提高存活率。
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来源期刊
Saudi Pharmaceutical Journal
Saudi Pharmaceutical Journal PHARMACOLOGY & PHARMACY-
CiteScore
6.10
自引率
2.40%
发文量
194
审稿时长
67 days
期刊介绍: The Saudi Pharmaceutical Journal (SPJ) is the official journal of the Saudi Pharmaceutical Society (SPS) publishing high quality clinically oriented submissions which encompass the various disciplines of pharmaceutical sciences and related subjects. SPJ publishes 8 issues per year by the Saudi Pharmaceutical Society, with the cooperation of the College of Pharmacy, King Saud University.
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