β-blockade in sepsis: regulation of persisting sepsis-related tachycardia

There is a sense of fatigue within the critical care community at the number of large, well run, interventional sepsis trials aimed at improving systemic haemodynamics that have not shown statistical separation between control and intervention groups. Nevertheless, post-hoc analyses of larger trials indicate that some subgroups of patients could benefit from cardiovascular intervention; with the implication that just as many may have come to harm by the same intervention. It is with this background that intensive care unit (ICU) clinicians have begun to realise the need to identify subgroups within a septic cohort. In some patients, protracted endogenous and exogenous sympathetic overstimulation, marked by persisting tachycardia, has been shown to be harmful despite initial improvement in haemodynamic response. In this context, the duration as well as the total dose of catecholamine therapy and the detrimental effects of tachycardia are associated with poor outcomes. 1 Schmittinger CA Torgersen C Luckner G Schröder DC Lorenz I Dünser MW Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study. Intensive Care Med. 2012; 38: 950-958 Crossref PubMed Scopus (129) Google Scholar , 2 Sander O Welters ID Foëx P Sear JW Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications. Crit Care Med. 2005; 33: 81-88 Crossref PubMed Scopus (80) Google Scholar Targeting such patients might present a phenotypic or genetic subgroup with an especially poor prognosis out of the heterogenous septic population. Efficacy and safety of landiolol, an ultra-short-acting β1-selective antagonist, for treatment of sepsis-related tachyarrhythmia (J-Land 3S): a multicentre, open-label, randomised controlled trialLandiolol resulted in significantly more patients with sepsis-related tachyarrhythmia achieving a heart rate of 60–94 bpm at 24 h and significantly reduced the incidence of new-onset arrhythmia. Landiolol was also well tolerated, but it should be used under appropriate monitoring of blood pressure and heart rate owing to the risk of hypotension in patients with sepsis and septic shock. Full-Text PDF