Key result
Esmolol significantly reduced 28-day mortality compared to standard treatment in patients with septic shock and tachycardia (RR 0.66).
Why the study?
It remained uncertain whether patients with septic shock can benefit from esmolol treatment.
Does esmolol reduce 28-day mortality in septic shock patients with tachycardia?
Meta-Analysis (n=927)
Does esmolol reduce 28-day mortality in septic shock patients with tachycardia?
Relative Risk: 0.66 (95% CI 0.56–0.77)
p-value: p=<0.001
In patients with septic shock and tachycardia, the addition of esmolol to standard therapy may reduce 28-day mortality and heart rate without compromising mean arterial pressure.
Supports esmolol in tachycardic septic shock; reinforces mortality benefit across pooled trials.
Purpose: The meta-analysis aims to identify whether septic shock patients can benefit from esmolol. Materials and Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, United States)was used for statistical analysis. Results: A total of 14 studies were identified and incorporated into the meta-analysis. For overall analysis, the treatment of esmolol was associated with decreased 28-day mortality (RR = 0.66, 95% CI = 0.56–0.77, p < 0.001). Meanwhile, our analysis found that, esmolol could decrease HR (SMD: −1.70; 95% CI: [−2.24−(−1.17)], cTnI (SMD: −1.61; 95% CI: [−2.06−(−1.16)] compared with standard treatment. No significant differences between the two groups were found in MAP, Lac, CI, and SVI. Conclusion: The findings of this meta-analysis intend to demonstrate that septic shock patients with high heart beats rate might be benefit from esmolol treatment despite enough fluid resuscitation. While, dependent on the study published, with the further development of septic shock, the positive impact of esmolol varies. The appropriate heart rate change interval cannot be confirmed, further high-quality and large-scale RCTs should be performed to verify it and screening more suitable heart rate levels.
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Huang et al. (2021) conducted a meta-analysis in Septic shock with tachycardia (n=927). Esmolol vs. Standard therapy was evaluated on 28-day mortality (RR 0.66, 95% CI 0.56-0.77, p=<0.001). Esmolol significantly reduced 28-day mortality compared to standard treatment in patients with septic shock and tachycardia (RR 0.66).
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