Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock

Betablockade has been shown to have cardioprotective effects in patients under perioperative stress. Besides animal model of septic shock and a small cohort of septic patients, these benefits have not been studied in septic shock patients who require norepinephrine administration. After correction of preload, an esmolol bolus (0.2-0.5 mg/kg) followed by continuous 24 h infusion was administered in septic patients with sinus or supraventricular tachycardia (HR > 120/min). Exclusion criteria were severe LV systolic dysfunction, atrioventricular blockade and norepinephrine infusion at rates over 0.5 mg/kg/min. Monitoring with echocardiography and pulmonary artery catheter before, at 2, 6, 12, 24 h following the start and 6 h after ceasing of the esmolol drip. Patients were maintained normovolemic throughout the study and adjustments of concomitant norepinephrine infusion rates were made as required. Ten septic patients (mean age 54.4 +/- 18.7), APACHE II 21.5 +/- 6.2, CRP 275 +/- 78 mg/l, procalcitonin 14.5 +/- 10.1 mg/l, were given esmolol drip of 212.5 +/- 63.5 mg/h at start to 272.5 +/- 89.5 mg/h at 24 h. Heart rate decreased from mean 142 +/- 11/min to 112 +/- 9/min (p < 0.001) with parallel insignificant reduction of cardiac index (4.94 +/- 0.76 to 4.35 +/- 0.72 l/min/m(2)). Stroke volume insignificantly increased from 67.1 +/- 16.3 ml to 72.9 +/- 15.3 ml. No parallel change of pulmonary artery wedge pressure was observed (15.9 +/- 3.2 to 15.0 +/- 2.4 mmHg) as well as no significant changes of norepinephrine infusion (0.13 +/- 0.17 to 0.17 +/- 0.19 mg/kg/min), DO2, VO2, OER or arterial lactate. Saving the heart 30 beats/min did not demonstrate adverse impact on global haemodynamics in rates above 110/min. Using well titratable betablocker seems to be safe and cardioprotective in septic shock patients with high cardiac output.