Key result
Targeted heart rate control preserves hemodynamics in septic shock without altering MAP or cardiac index.
Why the study?
Heart rate control with beta-blockers in sepsis was traditionally avoided over concerns of worsening cardiac index and organ perfusion, prompting an evaluation of targeted heart rate control for persistent tachycardia.
Does targeted heart rate control reduce 28-day mortality in adult patients with septic shock and persistent tachycardia?
Meta-Analysis
Does targeted heart rate control reduce 28-day mortality in adult patients with septic shock and persistent tachycardia?
Targeted heart rate control in septic shock appears to be tolerated hemodynamically, but its beneficial effect on mortality remains uncertain.
Objectives: Heart rate control using beta-blockers in sepsis has traditionally been avoided because of concerns with worsening cardiac index and organ perfusion. Recent studies has explored the possible beneficial effects of targeted heart rate control in patients with septic shock who have tachycardia despite initial resuscitation. We performed a systematic review and meta-analysis to explore the effects of heart rate control in septic shock patients. Methods: A systematic review and meta-analysis was conducted searching for studies from PubMed, Cochrane Central, and Embase registers for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with targeted rate control. The literature search was done to include studies from January 2013 to December 2023. Two independent researchers independently assessed the studies and included RCTS in which adult patients (>18 years of age) with septic shock were treated with targeted heart rate control vs placebo after initial resuscitation due to persistent tachycardia. The study data was extracted by two independent researchers. A random effects model was used to present the results. A trial sequential analysis (TSA) was performed for the primary outcome of 28-day mortality. Results: -value < 0.001) but no difference in mean arterial pressure. cardiac index, lactate levels, norepinephrine (NE) requirements, and ICU length of stay (LOS) in between the groups. Conclusion: Targeted heart rate control in patients with septic shock may be tolerated from a hemodynamic standpoint. However, the beneficial effect on mortality is less certain than was reported in the initial studies. How to cite this article: Datta PK, Sathe P, Roy A, Baronia T, Bhattacharjee A, Kundu R. The Clinical Utility of Targeted Heart Rate Control in Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis. Indian J Crit Care Med 2024;28(12):1170-1179.
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Bhattacharjee et al. (2024) conducted a meta-analysis in septic shock. Targeted heart rate control vs. placebo was evaluated on 28-day mortality. Targeted heart rate control in septic shock was hemodynamically tolerated with no difference in mean arterial pressure or cardiac index, though an unspecified metric was significant (P<0.001).
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