Y W Yu1, T W Sun, Y D Wan, Z Q Liu, Q C Kan. 1. Department of Integrated Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Abstract
OBJECTIVE: To evaluate the effect of β-blockers in patients with septic shock. METHODS: PubMed, EMBASE, Cochrane central registration of controlled trials, CNKI and Wanfang Data were searched to identify relevant studies from inception to October 2015.Statistical analysis was performed using STATA 12.0.The random effects model was used due to wide clinical variability across the trials. RESULTS: After application of the inclusion criteria, 7 trials with 392 patients were included, involving 3 randomized controlled trials (RCT) and 4 quasi-experiments.The results of the meta-analysis for the quasi-experiments showed that compared with baseline, heart rates (standardized mean difference (SMD)=-2.51, 95%CI: -4.32--0.70, P=0.007) and lactate levels (SMD=-0.34, 95%CI: -0.67--0.02, P=0.039) significantly decreased, while no significant differences were seen for mean arterial pressure (SMD=0.01, 95%CI: -0.42-0.44, P=0.969), cardiac index (SMD=-0.35, 95%CI: -1.15-0.44, P=0.385) or norepinephrine requirements (SMD=-0.06, 95%CI: -0.38-0.27, P=0.726) after 24-hour therapy. Among randomized controlled trials, β-blockers, compared with standard care, was associated with reductions in heart rates (P<0.001) , 28-day mortality (RR=0.60, 95%CI: 0.48-0.75, P<0.001) and troponin I levels (P<0.001). While no differences were found between the two groups in other hemodynamic and cardiac function variables, such as mean arterial pressure, cardiac index or stroke volume index (P>0.05). CONCLUSIONS: The currently available evidence indicates that the use of β-blockers is associated with a significant decrease in heart rate, troponin I levels and 28-day mortality in patients with septic shock, while mean arterial pressure, cardiac index and stroke volume index might remain unchanged.Large scale, muti-center RCTs need to be carried out to confirm the effects of β-blockers in patients with septic shock.
OBJECTIVE: To evaluate the effect of β-blockers in patients with septic shock. METHODS: PubMed, EMBASE, Cochrane central registration of controlled trials, CNKI and Wanfang Data were searched to identify relevant studies from inception to October 2015.Statistical analysis was performed using STATA 12.0.The random effects model was used due to wide clinical variability across the trials. RESULTS: After application of the inclusion criteria, 7 trials with 392 patients were included, involving 3 randomized controlled trials (RCT) and 4 quasi-experiments.The results of the meta-analysis for the quasi-experiments showed that compared with baseline, heart rates (standardized mean difference (SMD)=-2.51, 95%CI: -4.32--0.70, P=0.007) and lactate levels (SMD=-0.34, 95%CI: -0.67--0.02, P=0.039) significantly decreased, while no significant differences were seen for mean arterial pressure (SMD=0.01, 95%CI: -0.42-0.44, P=0.969), cardiac index (SMD=-0.35, 95%CI: -1.15-0.44, P=0.385) or norepinephrine requirements (SMD=-0.06, 95%CI: -0.38-0.27, P=0.726) after 24-hour therapy. Among randomized controlled trials, β-blockers, compared with standard care, was associated with reductions in heart rates (P<0.001) , 28-day mortality (RR=0.60, 95%CI: 0.48-0.75, P<0.001) and troponin I levels (P<0.001). While no differences were found between the two groups in other hemodynamic and cardiac function variables, such as mean arterial pressure, cardiac index or stroke volume index (P>0.05). CONCLUSIONS: The currently available evidence indicates that the use of β-blockers is associated with a significant decrease in heart rate, troponin I levels and 28-day mortality in patients with septic shock, while mean arterial pressure, cardiac index and stroke volume index might remain unchanged.Large scale, muti-center RCTs need to be carried out to confirm the effects of β-blockers in patients with septic shock.