Andrea Morelli, M.D., of the University of Rome, Italy, and
colleagues conducted a study to investigate the effect of the
short-acting beta-blocker esmolol on the heart rate of patients with
severe septic shock and high risk of death.
Septic shock is associated with adverse effects on cardiac function.
Beta-blocker therapy controls heart rate and may improve cardiovascular
performance, but concerns remain that this therapy may lead to
cardiovascular decompensation (inability of the heart to maintain
adequate circulation), according to background information in the
The randomized phase 2 study was conducted in a university hospital
intensive care unit (ICU) between November 2010 and July 2012. It
recruited patients in septic shock with a heart rate of 95/min or higher
requiring high-dose norepinephrine to maintain an average arterial
pressure of 65 mm Hg or higher. The researchers randomly assigned 77
patients to receive a continuous infusion of esmolol to maintain heart
rate between 80 beats per minute (BPM) and 94 BPM for the duration of
their ICU stay and 77 patients to standard treatment. The primary
outcome was a reduction in heart rate below the predefined threshold of
95 BPM and maintain a heart rate between 80 and 94 BPM over a 96-hour
The researchers found that the target range for heart rate was
achieved in all patients in the esmolol group, which was significantly
lower throughout the intervention period than what was achieved in the
control group. In addition, the esmolol group had a 28-day mortality
rate of 49.4 percent vs. 80.5 percent in the control group. Overall
survival was higher in the esmolol group.
There was no clinically relevant differences between groups in other
investigated cardiopulmonary variables nor in rescue therapy
“Further investigation of the effects of esmolol on clinical outcomes is warranted,” the authors write.
Source: The JAMA Network (doi:10.l001/jama.2013.278477)
The presentation of this study at the ESICM is available at this link: