What does this research mean for the field?

Beta-blockers, aspirin, and heparin may reduce mortality in septic patients under mechanical ventilation, whereas current evidence does not strongly support the use of statins for improving survival. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 10, 2023Open Access

Role of aspirin, beta-blocker, statins, and heparin therapy in septic patients under mechanical ventilation: a narrative review

Q: What is the clinical evidence from this study?

Study design: Review. Population: Sepsis (n=1969965). Intervention: Beta-blockers, aspirin, statins, and heparin vs. Standard treatment. Primary outcome: Mortality.

LALou’i Al-HusinatYarmouk University AHAmer Abu HmaidYarmouk University HAHadeel AbbasImam Sadiq University

Key Result

Beta-blockers, aspirin, and heparin may reduce mortality in septic patients, whereas evidence does not support the use of statins for improving survival.

Structured PICO

Do beta-blockers, aspirin, statins, and heparin reduce mortality in septic patients under mechanical ventilation?

Population

Septic patients under mechanical ventilation with non-cardiovascular diseases (n=1,969,965 from 36 studies)

Intervention

Beta-blockers, aspirin, statins, and heparin as adjunctive treatments

Comparator

Standard treatment

Outcome

Mortalityhard clinical

Adjunctive use of beta-blockers, aspirin, and heparin may reduce mortality in septic patients on mechanical ventilation, though further randomized trials are needed, while statins do not show strong evidence of benefit.

Limitations

Potential confounding factors such as the varying dose and treatment period of each drug
Combination with other drugs as anticoagulant increased the heterogeneity among the included studies
Did not approach the individual and genomic influence on pharmacological actions in septic patients
Only databases in English were included in this study

Abstract

Sepsis is the main cause of death among patients admitted to intensive care units. Management of sepsis includes fluid resuscitation, vasopressors, intravenous antimicrobials, source control, mechanical ventilation, and others. New insights into the potential benefits of non-antimicrobial drugs in sepsis have evolved based on the pathophysiology of the disease and the mechanism of action of some drugs, but the findings are still controversial. In this study, we aimed to evaluate the effect of beta-blockers, aspirin, statins, and heparin as adjunctive treatments in septic patients under mechanical ventilation with non-cardiovascular diseases and their effect on mortality. We searched PubMed with relevant keywords (beta-blockers, aspirin, statins, or heparin, and critically ill or sepsis) for the last 10 years and some personal collection of relevant articles, and then we assessed studies according to prespecified inclusion and exclusion criteria. Our results show that beta-blockers, aspirin, and heparin may have promising feedback on reducing mortality. However, new well-controlled, randomized, multicenter studies are needed to confirm that, and multiple issues regarding their usage need to be addressed. On the other hand, the feedback regarding the effectiveness of statins was not as strong as that of the other drugs studied, and we suggest that further research is needed to confirm these results.

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