Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, University Hospital of Bielefeld, Campus Bielefeld-Bethel, University of Bielefeld, Burgsteig 13, Haus Gilead I, 33617, Bielefeld, Germany.
Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Crit Care. 2024 Nov 27;28(1):392. doi: 10.1186/s13054-024-05174-w.
Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.
The data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm.
A total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, - 0.10 [95% CI, - 0.22 to 0.02]; p = 0.11; p for Cochran's Q test = 0.001; I = 73%). No difference was seen when comparing patients aged < 65 versus ≥ 65 years (p = 0.11) or sinus tachycardia with atrial fibrillation (p = 0.27). Despite statistical heterogeneity, no significant publication bias was observed.
Administration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.
在脓毒症患者中使用短效β受体阻滞剂的治疗仍然存在争议。最近的两项大型多中心试验为这种治疗方法提供了额外的证据。因此，我们进行了一项荟萃分析，包括最新的数据，以评估在成年脓毒症患者中使用短效β受体阻滞剂治疗对死亡率的潜在影响。
数据搜索包括 PubMed、Web of Science、ClinicalTrials.gov 和 Cochrane Library。根据 PRISMA 声明，对所有符合条件的同行评议研究进行了荟萃分析。仅纳入了有明确脓毒症分类且静脉给予短效β受体阻滞剂（拉贝洛尔或艾司洛尔）的随机对照研究。短期死亡率作为主要终点。次要终点包括短效β受体阻滞剂治疗对年龄和心律的短期死亡率的影响。
共有七项研究总结了 854 名符合预设标准的患者，被纳入分析。与对照组相比，短效β受体阻滞剂治疗并未显著影响短期死亡率和（最长的死亡率数据）汇总死亡率（风险差，-0.10 [95% CI，-0.22 至 0.02]；p=0.11；Cochran's Q 检验 p=0.001；I=73%）。比较年龄<65 岁与≥65 岁的患者（p=0.11）或窦性心动过速与心房颤动的患者（p=0.27）时，结果无差异。尽管存在统计学异质性，但未观察到明显的发表偏倚。
在持续性心动过速的脓毒症患者中，给予短效β受体阻滞剂并不能降低短期死亡率。未来的研究还应提供广泛的血流动力学数据，以便在治疗前后对心脏功能进行特征描述。
