Guarracino Fabio, Cortegiani Andrea, Antonelli Massimo, Behr Astrid, Biancofiore Giandomenico, Del Gaudio Alfredo, Forfori Francesco, Galdieri Nicola, Grasselli Giacomo, Paternoster Gianluca, Rocco Monica, Romagnoli Stefano, Sardo Salvatore, Treskatsch Sascha, Tripodi Vincenzo Francesco, Tritapepe Luigi
Cardiothoracic and Vascular Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
J Anesth Analg Crit Care. 2023 Oct 23;3(1):41. doi: 10.1186/s44158-023-00126-2.
The role of β-blockers in the critically ill has been studied, and data on the protective effects of these drugs on critically ill patients have been repeatedly reported in the literature over the last two decades. However, consensus and guidelines by scientific societies on the use of β-blockers in critically ill patients are still lacking. The purpose of this document is to support the clinical decision-making process regarding the use of β-blockers in critically ill patients. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient's care process.
The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects underlying the use of β-blockers in critically ill adult patients. The methodology followed by the experts during this process was in line with principles of modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales in the form of informative text. The overall list of statements was subjected to blind votes for consensus.
The literature search suggests that adrenergic stress and increased heart rate in critically ill patients are associated with organ dysfunction and increased mortality. Heart rate control thus seems to be critical in the management of the critically ill patient, requiring careful clinical evaluation aimed at both the differential diagnosis to treat secondary tachycardia and the treatment of rhythm disturbance. In addition, the use of β-blockers for the treatment of persistent tachycardia may be considered in patients with septic shock once hypovolemia has been ruled out. Intravenous application should be the preferred route of administration.
β-blockers protective effects in critically ill patients have been repeatedly reported in the literature. Their use in the acute treatment of increased heart rate requires understanding of the pathophysiology and careful differential diagnosis, as all causes of tachycardia should be ruled out and addressed first.
β受体阻滞剂在危重症患者中的作用已得到研究，在过去二十年里，关于这些药物对危重症患者保护作用的数据在文献中被反复报道。然而，科学协会对于在危重症患者中使用β受体阻滞剂仍缺乏共识和指南。本文的目的是支持关于在危重症患者中使用β受体阻滞剂的临床决策过程。本文的受众是医生、护士、医护人员以及参与患者护理过程的其他专业人员。
意大利麻醉、镇痛、复苏与重症监护学会（SIAARTI）挑选了一组专家，要求他们确定在成年危重症患者中使用β受体阻滞剂的关键要点。在此过程中专家们遵循的方法符合改良德尔菲法和兰德-加州大学洛杉矶分校法的原则。专家们以信息性文本的形式制定声明和支持理由。声明的总体列表进行了无记名投票以达成共识。
文献检索表明，危重症患者的肾上腺素能应激和心率增加与器官功能障碍及死亡率增加相关。因此，心率控制在危重症患者的管理中似乎至关重要，这需要进行仔细的临床评估，既要针对继发性心动过速进行鉴别诊断，也要治疗心律失常。此外，一旦排除低血容量，对于感染性休克患者，可考虑使用β受体阻滞剂治疗持续性心动过速。静脉给药应作为首选给药途径。
β受体阻滞剂对危重症患者的保护作用在文献中已被反复报道。在急性心率增加的治疗中使用β受体阻滞剂需要了解病理生理学并进行仔细的鉴别诊断，因为应首先排除并处理所有心动过速的原因。
