Faculty Opinions recommendation of Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial.

2014 ◽  
Author(s):  
Randal Dull ◽  
Mehmet Ozcan
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Septic Shock ◽  
Randomized Clinical Trial ◽  
Clinical Outcomes ◽  
Rate Control ◽  
Heart Rate Control

scholarly journals Comparative Study between Ivabradine Versus Bisoprolol Effects for Heart Rate Control on Hemodynamics and Clinical Outcomes in Patients with Septic Shock

2021 ◽  
pp. 58-68
Author(s):  
Omnia Ali El-Miseery ◽  
Hesham Elsaid Elashry ◽  
Magdy Elsaid Elbably ◽  
Magdy Elsaid Elbably ◽  
Ahmed Mohammed Hamed
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Septic Shock ◽  
Cardiac Output ◽  
Clinical Outcomes ◽  
Nasogastric Tube ◽  
Rate Control ◽  
Conventional Therapy ◽  
The Other ◽  
Heart Rate Control

Background: Septic shock is associated with excessive sympathetic outflow, high plasma catecholamine levels, myocardial depression, vascular hypo-reactivity, and autonomic dysfunction. Typically, patients have a low resistance, high cardiac output circulation with tachycardia and arterial hypotension that may be poorly or even nonresponsive to exogenous catecholamine vasopressors. The aim of the present study was to compare the effect of ivabradine vs bisoprolol for heart rate control on the hemodynamics and clinical outcomes in patients with septic shock. Methods: The study was carried out on 90 patients, aging from 18 to 60 years of both sex presented with septic shock in ICU. Patients were randomly classified into 3 equal groups each of 30 patients. Group I (Control group) received conventional therapy. Group II (Bisoprolol group) received conventional therapy plus bisoprolol 5 mg once daily & one placebo pill on 12 hrs interval via nasogastric tube for 7 days. Group III (Ivabradine group) received conventional therapy plus ivabradine 5 mg twice daily on 12 hrs interval via nasogastric tube for 7 days. Results: Both bisoprolol and ivabradine effectively lowered heart rate in septic shock patients but ivabradine was more effective than bisoprolol. Both bisoprolol and ivabradine did not affect mean blood pressure, with ivabradine being more effective in maintaining blood pressure than bisoprolol. Noradrenaline dose was lower in ivabradine group in comparison with the other two groups. As regard to stroke volume & cardiac output, there was improvement in ivabradine group in comparison with bisoprolol and control groups. As regard to serum lactate level, there was improvement in ivabradine group in comparison with the other two groups. Both bisoprolol & ivabradine resulted in reduction in LOS & 28-day mortality with no significant difference between both groups. Conclusions: Controlling heart rate in septic shock patients with either bisoprolol or ivabradine improves outcomes. Ivabradine is better than bisoprolol in maintaining hemodynamics and improving tissue perfusion parameters.

Effect of Heart Rate Control With Esmolol on Hemodynamic and Clinical Outcomes in Patients With Septic Shock

JAMA ◽  
2013 ◽  
Vol 310 (16) ◽  
pp. 1683 ◽  
Author(s):  
Andrea Morelli ◽  
Christian Ertmer ◽  
Martin Westphal ◽  
Sebastian Rehberg ◽  
Tim Kampmeier ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Clinical Outcomes ◽  
Rate Control ◽  
Heart Rate Control

Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock

2013 ◽  
Vol 41 (9) ◽  
pp. 2162-2168 ◽  
Author(s):  
Andrea Morelli ◽  
Abele Donati ◽  
Christian Ertmer ◽  
Sebastian Rehberg ◽  
Tim Kampmeier ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Rate Control ◽  
Heart Rate Control

scholarly journals Effects of Esmolol on Vascular Waterfall Phenomenon in Septic Shock Patients by Bedside Measurement of Critical Closure Pressure and Mean Systemic Filling Pressure: A Prospective Observational Study

2021 ◽  
Author(s):  
Zehan Liu ◽  
Chuanliang Pan ◽  
Jianping Liu ◽  
Hui Liu ◽  
Hui Xie
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Rate Control ◽  
Oxygen Supply ◽  
Supply And Demand ◽  
Filling Pressure ◽  
The Body ◽  
Heart Rate Control ◽  
Hemodynamic Optimization ◽  
The Difference

Abstract Background To explore the effect of esmolol on the vascular waterfall phenomenon and body oxygen supply and demand in septic shock patients by bedside measurements of critical closure pressure (Pcc) and mean systemic circulation filling pressure (Pmsf). Methods Enrolled in the Intensive Care Medicine Unit (ICU) of the Third People's Hospital of Chengdu City/Southwest Jiaotong University Hospital from August 2019 to January 2021, admitted to our department for infectious shock. Adults with endotracheal intubation, invasive ventilator-assisted ventilation, pulse-indicated continuous cardiac output monitoring (PiCCO) catheters and deep venous catheters placed for medical reasons. Results After 24 hours of initial hemodynamic optimization, 56 patients were finally enrolled. After heart rate control with esmolol, patients had a significant decrease in cardiac index (CI) (4.0 vs. 3.3 L/min/m2, p < 0.001), a significant increase in stroke index (SI) (34.1 vs. 36.6 ml/m2, p < 0.01), and a significant decrease in heart rate (HR) (116.8 vs. 90.6 beats/min, p < 0.001). After 1 hour of treatment with esmolol, patients had a significant increase in Pcc (31.4 vs 36.7 mmHg, p < 0.01). The difference between Pcc and Pmsf before and after treatment was statistically different (4.0 vs 10.0 mmHg, p < 0.01). After heart rate control with esmolol, the patients had a significant increase in the body circulation vascular resistance indices (RIs) (15.14 vs 18.25 mmHg/min/m2-L-1, p < 0.001). There was an increase in ScvO2 in patients after treatment with esmolol, but the difference was not statistically significant (68.4% vs 69.8%, p > 0.05), while Pcv-aCO2 was significantly lower (6.3 vs 4.9 mmHg, p < 0.001) and patients had a significant decrease in blood lactate levels (4.0 vs 3.6 mmol/L, p < 0.05) . Conclusion Patients with septic shock whose heart rate was still greater than 95 beats/min after hemodynamic optimization were treated with esmolol, which could effectively control heart rate and reduce CI, as well as improve Pcc and increase the difference between Pcc and Pmsf, without affecting MAP, CVP, Pmsf and arteriovenous vascular resistance, and improve the balance of oxygen supply and demand in the body.

scholarly journals If Channel Inhibition - Ivabradine for the Treatment of Heart Failure

2019 ◽  
Vol 17 ◽  
Author(s):  
Giuseppe Rosano ◽  
Cristiana Vitale
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Rate Control ◽  
Beta Blockers ◽  
The Novel ◽  
Heart Rate Control ◽  
Channel Inhibition ◽  
Clinical Trial Evidence ◽  
Trial Evidence

The novel first-in-class If channel antagonist, Ivabradine, is effective in improving clinical outcomes and functional capacity, in patients with HF, as well as demonstrating useful anti-anginal and protective anti-ischaemic effects. It can help improve heart rate control and can be usefully co-administered with beta blockers on HFrEF patients with residually elevated resting sinus rhythm heart rate. We review the clinical trial evidence for the benefits of Ivabradine in the treatment of heart failure.

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