(1441) Esmolol's Effect on Hemodynamics and Mortality in Septic Shock: A Comprehensive Meta-Analysis

Introduction: Septic shock, a serious and often fatal condition, continues to be a significant concern within the healthcare community. Beta-blockers, specifically esmolol, have been proposed as potential therapeutic agents to manage hemodynamics in patients with septic shock. However, its exact influence on patient outcomes has not been definitively established. Therefore, a systematic review of the current literature is warranted. This study aims to evaluate the influence of esmolol in patients suffering from septic shock.

Methods: A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Library databases until January 2023. We included studies investigating esmolol's effects in patients with septic shock. The focus was on key outcomes such as overall mortality (assessed via Relative Risk), lactic acid levels, MAP, and heart rate (evaluated through Mean Difference). R software (version 4.0.3), supplemented with metafor and meta packages, was employed for all statistical analyses using a random-effects model.

Results: Our search identified 5 studies involving a total of 402 patients (199 patients in the esmolol group and 203 in the control group). Administration of esmolol was associated with a significant reduction in overall mortality (Relative Risk: 0.65; 95% CI: 0.48 to 0.89, P< 0.01, I2=58%). Esmolol use also led to a significant decrease in heart rate (Mean Difference: -21.94 beats/min; 95% CI: -34.49 to -9.38, P< 0.01, I2=93%). However, lactic acid levels showed no significant difference (Mean Difference: -0.01; 95% CI: -0.68 to 0.67, P=0.99, I2=94%), and MAP was marginally maintained (Mean Difference: -0.92 mmHg; 95% CI: -1.86 to 0.02, P=0.06, I2=0%).

Conclusions: Our analysis suggests that esmolol administration can significantly reduce mortality and heart rate in patients with septic shock, potentially improving hemodynamic stability. However, esmolol does not seem to affect lactic acid levels or MAP significantly. Given the high heterogeneity in some of the outcomes and the limited number of studies, more robust, large-scale, randomized controlled trials are needed to provide a more definitive understanding of esmolol's role and optimal usage in managing septic shock.