Effect of Heart Rate Control on Oxygenation and Vasopressor Need in Sepsis and Septic Shock-A Pilot Randomised Controlled Study
Journal Title: Turkish Journal of Intensive Care - Year 2020, Vol 18, Issue 4
Abstract
Objective: The goal of this study was to examine the effect of keeping resting heart rate below 95 bpm on oxygenation, organ function, vasopressor need and mortality in sepsis and septic shock. Materials and Methods: Patients admitted to our intensive care unit with sepsis or septic shock diagnosis between June 2015 and July 2017 were included in the study. On the other hand, patients with a history of chronic β-blocker use, structural heart disease or permanent arrhythmia were excluded. After randomisation, patients in the study group (group BB) were given short-acting β1-blocker (esmolol) infusion to achieve resting heart rates between 85 and 95 bpm for 4 d. In both groups, 28-d mortality, vasopressor need and oxygenation parameters were recorded. Moreover, the results are presented as preliminary evaluation. Results: Fifty-two patients were included in the study. Further, 27 patients were in the group BB, while the remaining patients were in the control group (group NOBB). Pneumonia was the most common cause of sepsis (p>0.05). The APACHE II values in both groups were identical (p>0.05). Although the 28 d mortality rates decreased in the group BB, no statistical significance was observed due to insufficient sample size (p>0.05). The need for vasopressors also appeared to decrease on daily follow-up (p>0.05). In addition, the ratios of PaO2/FiO2 were higher in the group BB than in the group NOBB on day 3 (p<0.05). There was no difference in invasive mechanical ventilation, non-invasive mechanical ventilation, renal replacement therapy durations and length of stay (p>0.05). Also, no cardiac adverse effects associated with the intervention were observed. Conclusion: In this pilot study, we observed that cardio-selective β-adrenergic blockade could attenuate sepsis-related cardiac dysfunction. Decreased norepinephrine requirements and lactate levels, although not statistically significant, were consistent with a decrease in 28 d mortality rates. Despite enhanced oxygenation, mechanical ventilation durations did not vary in the group BB. In conclusion, we found that β1-receptor blockade had no detrimental effect on organ functions in sepsis. Moreover, it may be beneficial for cardiac and respiratory functions.
Authors and Affiliations
Emre Sertaç Bingül, Günseli Orhun, Perihan Ergin Özcan, Figen Esen
Keywords
Related Articles
- EP ID EP691617
- DOI 10.4274/tybd.galenos.2019.04934
- Views 110
- Downloads 0
Evidence-based Practices in the Prevention of Central Venous Catheter Infections: Knowledge of Intensive Care Nurses
Objective: This study aimed to determine the knowledge level of intensive care nurses regarding evidence-based practices in the prevention of infections related to the Central Venous Catheter (CVC). Materials and Method...
The Effect of Endotracheal Tube Cuff Pressure Control Training on Nurses’ Knowledge Level
Objective: This study was designed to investigate the effect of endotracheal tube cuff pressure training on the knowledge level of intensive care nurses. Materials and Methods: This quasi-experimental study was conducte...
New Enemy of Refugees: Tuberculosis
Objective: Tuberculosis (TB) remains a major concern to public health in Turkey. The disease can cause respiratory failure and is monitored in intensive care units (ICU) for various clinical symptoms, such as meningitis....
Examination of a Newborn with Necrotizing Enterocolitis According to Neuman Systems Model
Necrotizing Enterocolitis (NEC) is one of the most common problems with gastrointestinal system in newborns. The aim of the study was to evaluate the nursing care that should be applied in newborns diagnosed with NEC wi...
The Effect of Early Enteral Immunonutrition to Inflammatory Response for Intensive Care Patients
Objective: Early enteral immunonutrition affects cytokine-dependent stress response, providing an optimal inflammatory and immune response in the dynamic process of SIRS through sepsis. In our study, we examined the infl...