Effect Of Heart Rate Control On Oxygenation And Vasopressor Need In Sepsis And Septic Shock-A Pilot Randomised Controlled Study

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 beta-blocker use, structural heart disease or permanent arrhythmia were excluded. After randomisation, patients in the study group (group BB) were given short-acting beta 1-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/FiO(2) 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 beta-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 beta 1-receptor blockade had no detrimental effect on organ functions in sepsis. Moreover, it may be beneficial for cardiac and respiratory functions.