Anest. intenziv. Med. 2013;24(6):403-409

The heart in septic shock and beta-blockade. Reconsidering the paradox?Intesive Care Medicine - Special Article

Matějovič Martin

I. interní klinika, Lékařská fakulta v Plzni, Univerzita Karlova v Praze, Fakultní nemocnice Plzeň

Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova v Praze, Plzeň, Česká republika

Myocardial depression is a well-recognized consequence of septic shock. A growing body of evidence suggests that excessive catecholamine levels exert toxic effects on the heart, thereby contributing to the development of septic myocardial dysfunction. Although seemingly counter-intuitive, beta-blockade aimed at the attenuation of the sympatho-adrenergic stress may represent a plausible concept in protecting the heart during septic shock. Limited experimental and clinical evidence indicates that careful control of heart rate using short-acting beta-1 selective blockers might economize cardiac work without exerting adverse systemic haemodynamiceffects in septic subjects. Rigorous testing of this concept in randomized clinical trials is needed before it can be implemented in clinical practice. This article briefly introduces the concept of de-catecholaminisation and discusses the pros and cons of this emerging paradigm.

Keywords: septic shock; beta-blockade; esmolol; hemodynamics; heart failure

Published: December 1, 2013  Show citation