Key result
Metoprolol targeting 60-70 bpm in septic shock improves day-1 MAP by ~10 mmHg versus higher targets.
Why the study?
Despite decreased septic shock mortality, no therapies have yet been discovered to alter the clinical course of sepsis once established.
Does targeting a heart rate of 60-70 beats/min with enteral metoprolol tartrate improve hemodynamics and clinical outcomes in septic shock patients compared to higher heart rate targets?
RCT (n=90)
Randomized
Does targeting a heart rate of 60-70 beats/min with enteral metoprolol tartrate improve hemodynamics and clinical outcomes in septic shock patients compared to higher heart rate targets?
Absolute Event Rate: 61.73% vs 51.33%
p-value: p=< 0.001
Targeting a strict heart rate of 60-70 beats/min with metoprolol in septic shock improves hemodynamics, tissue perfusion, and reduces ICU stay, though it does not affect 28-day mortality.
Supports targeting HR 60-70 bpm with metoprolol in septic shock for improved hemodynamics and shorter ICU stay; extends beta-blocker evidence beyond mortality endpoints.
Introduction Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis’s course once it is infected. Objective The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups. Methods Septic shock patients ( n =90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150 mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR = 60-70 beats/min), group B (HR = 71-80 beats/min), and group C (HR = 81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO 2 ), serum lactate, and sequential organ failure assessment (SOFA) score. Results After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) ( P < 0.001). After 3 days, group A had a significantly improved SvO 2 , lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements ( P < 0.001) and shorter ICU stay ( P = 0.001). Conclusion Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit.
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Habib et al. (2023) conducted an RCT in Septic shock (n=90). Enteral metoprolol tartrate (target HR 60-70 beats/min) vs. Enteral metoprolol tartrate (target HR 71-80 or 81-90 beats/min) was evaluated on mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score (p=< 0.001). Targeting a heart rate of 60-70 beats/min with metoprolol tartrate in septic shock significantly improved mean arterial pressure at 1 day (61.73 vs 51.33 and 52.0 mmHg; P<0.001).
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