Beta-Adrenergic Blockade in Critical Illness

Overview

Journal Front Pharmacol

Date 2021 Nov 1

PMID 34721025

Citations 11

Authors

Rebecca Bruning

Hannah Dykes

Timothy W Jones

Nathaniel B Wayne

Andrea Sikora Newsome

Affiliations

Soon will be listed here.

Abstract

Catecholamine upregulation is a core pathophysiological feature in critical illness. Sustained catecholamine β-adrenergic induction produces adverse effects relevant to critical illness management. β-blockers (βB) have proposed roles in various critically ill disease states, including sepsis, trauma, burns, and cardiac arrest. Mounting evidence suggests βB improve hemodynamic and metabolic parameters culminating in decreased burn healing time, reduced mortality in traumatic brain injury, and improved neurologic outcomes following cardiac arrest. In sepsis, βB appear hemodynamically benign after acute resuscitation and may augment cardiac function. The emergence of ultra-rapid βB provides new territory for βB, and early data suggest significant improvements in mitigating atrial fibrillation in persistently tachycardic septic patients. This review summarizes the evidence regarding the pharmacotherapeutic role of βB on relevant pathophysiology and clinical outcomes in various types of critical illness.

Citing Articles

Beta-blocker administration within 24 hours after admission to the intensive care unit and mortality in critical heart failure patients: a retrospective analysis from the MIMIC-IV database.

Xie L, Chen J, Li Y, Liu G, Shen J, Li X Front Pharmacol. 2025; 16:1514138.

PMID: 40078276 PMC: 11897012. DOI: 10.3389/fphar.2025.1514138.

Mortality in septic patients treated with short-acting betablockers: a comprehensive meta-analysis of randomized controlled trials.

Alexandru M, Niewald P, Kruger S, Borgstedt R, Whitehouse T, Singer M Crit Care. 2024; 28(1):392.

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Association of beta blockers and mortality in adults with septic shock: systematic review and meta-analysis of randomized clinical trial.

Vasquez-Tirado G, Quispe-Castaneda C, Meregildo-Rodriguez E, Cuadra-Campos M, Segura-Plasencia N, Arbayza-Avalos Y Front Med (Lausanne). 2024; 11:1448573.

PMID: 39380732 PMC: 11458450. DOI: 10.3389/fmed.2024.1448573.

Safety and efficacy of early beta-blocker initiation in acute heart failure and cardiogenic shock: systematic review and meta-analysis.

Sinardja C, Jagannatha G, de Liyis B, Kosasih A Egypt Heart J. 2024; 76(1):126.

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The role of esmolol in sepsis: a meta-analysis based on randomized controlled trials.

Wei Y, Bo F, Wang J, Fu J, Qiu Y, Bi H BMC Anesthesiol. 2024; 24(1):326.

PMID: 39266951 PMC: 11391746. DOI: 10.1186/s12871-024-02714-3.

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