Benefits of esmolol in adults with sepsis and septic shock: An updated meta-analysis of randomized controlled trials

Jing Zhang, Chun Chen, Yi Liu, Yi Yang, Xiaolei Yang, Jin Yang, Jing Zhang, Chun Chen, Yi Liu, Yi Yang, Xiaolei Yang, Jin Yang

Abstract

Background: Sepsis affects millions of patients annually, resulting in substantial health and economic burdens globally. The role of esmolol potentially plays in the treatment of sepsis and septic shock in adult patients remains controversial.

Methods: We undertook a systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from their inception to May 12, 2022, for randomized controlled trials that evaluated the efficacy of esmolol for sepsis and septic shock. A random-effects meta-analysis was performed. Two investigators independently screened articles, extracted data, and assessed the quality of included studies.

Results: Eight studies from 7 randomized controlled trials were included in our meta-analysis of 503 patients with sepsis and/or septic shock. Compared with standard treatment, esmolol significantly decreased 28-day mortality (risk ratio 0.68, 95% confidence interval [CI] 0.52-0.88; P = .004), heart rate (standardized mean difference [SMD] -1.83, 95% CI -2.95 to -0.70, P = .001), tumor necrosis factor-a (SMD -0.48, 95% CI -0.94 to -0.02, P = .04), and the troponin I level (SMD -0.59, 95% CI -1.02 to -0.16, P = .008) 24 hours after treatment. No significant effect was found in terms of length of intensive care unit stay; mean arterial pressure, lactic acid, central venous pressure, or central venous oxygen saturation, interleukin 6, or white blood cell levels; stroke volume index; or the PaO2/FiO2 ratio.

Conclusions: Esmolol treatment may be safe and effective in decreasing 28-day mortality, controlling heart rate, and providing cardioprotective function, but has no effect on lung injury in patients with sepsis or septic shock after early fluid resuscitation. Improvement in cardiac function may be related to changes in serum inflammatory mediators. No significant adverse effects on tissue perfusion and oxygen utilization were observed.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1.
Figure 1.
A flow diagram of the study selection process. All studies were randomized controlled trials.
Figure 2.
Figure 2.
Risk of bias summary for the included studies.
Figure 3.
Figure 3.
A forest plot of 28-day mortality between the esmolol and control groups.
Figure 4.
Figure 4.
A forest plot of the heart rate between the esmolol and control groups.
Figure 5.
Figure 5.
A forest plot of the length of ICU stay between the esmolol and control groups. ICU = intensive care unit.
Figure 6.
Figure 6.
A forest plot of mean arterial pressure levels between the esmolol and control groups.
Figure 7.
Figure 7.
A forest plot of lactic acid levels between the esmolol and control groups.
Figure 8.
Figure 8.
A forest plot of the stroke volume index between the esmolol and control groups.
Figure 9.
Figure 9.
A forest plot of the cardiac index between the esmolol and control groups.
Figure 10.
Figure 10.
A forest plot of central venous pressure levels between the esmolol and control groups.
Figure 11.
Figure 11.
A forest plot of central venous oxygen saturation levels between the esmolol and control groups.
Figure 12.
Figure 12.
A forest plot of troponin I levels between the esmolol and control groups.
Figure 13.
Figure 13.
A forest plot of white blood cell levels between the esmolol and control groups.
Figure 14.
Figure 14.
A forest plot of interleukin 6 levels between the esmolol and control groups.
Figure 15.
Figure 15.
A forest plot of tumor necrosis factor-a levels between the esmolol and control groups.
Figure 16.
Figure 16.
A forest plot of the PO2/FiO2 ratio between the esmolol and control groups. PO2/FiO2, the ratio of arterial oxygen partial pressure (PaO2 in mm Hg) to fractional inspired oxygen.

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