The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44158-023-00126-2.

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Author and article information

Contributors

Andrea Cortegiani:

ORCID: http://orcid.org/0000-0003-1416-9993

andrea.cortegiani@unipa.it

Journal

Journal ID (nlm-ta): J Anesth Analg Crit Care

Journal ID (iso-abbrev): J Anesth Analg Crit Care

Title: Journal of Anesthesia, Analgesia and Critical Care

Publisher: BioMed Central (London )

ISSN (Electronic): 2731-3786

Publication date (Electronic): 23 October 2023

Publication date PMC-release: 23 October 2023

Publication date Collection: 2023

Volume: 3

Electronic Location Identifier: 41

Affiliations

[1 ]Cardiothoracic and Vascular Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, ( https://ror.org/05xrcj819) Pisa, Italy

[2 ]Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, ( https://ror.org/044k9ta02) Palermo, Italy

[3 ]Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, ( https://ror.org/044k9ta02) 90127 Palermo, Italy

[4 ]GRID grid.411075.6, ISNI 0000 0004 1760 4193, Department of Emergency, Anesthesiological and Resuscitation Sciences, , Policlinico Universitario A. Gemelli IRCCS, ; Rome, Italy

[5 ]GRID grid.518396.0, ISNI 0000 0004 0455 7965, Operative Unit of Anesthesia and Resuscitation, , Hospital of Camposampiero, ; Padua, Italy

[6 ]Anesthesia and Resuscitation Transplants, Department of Medical Pathology Surgical, Molecular and Critical Area, University of Pisa, ( https://ror.org/03ad39j10) Pisa, Italy

[7 ]Emergency Department, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy

[8 ]Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, ( https://ror.org/05xrcj819) Pisa, Italy

[9 ]General Cardiac Surgery Unit, Critical Area Department, Ospedale Dei Colli, Naples, Italy

[10 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Department of Anesthesia, Resuscitation and Emergency, , IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico, ; Milan, Italy

[11 ]Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, ( https://ror.org/00wjc7c48) Milan, Italy

[12 ]GRID grid.416325.7, Cardiovascular Anesthesia and ICU, San Carlo Hospital, ; Potenza, Italy

[13 ]Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, ( https://ror.org/02be6w209) Rome, Italy

[14 ]Anesthesia and Intensive Care Section, Department of Health Sciences, University of Florence, ( https://ror.org/04jr1s763) Florence, Italy

[15 ]GRID grid.24704.35, ISNI 0000 0004 1759 9494, Department of Anesthesia and Intensive Care, , Careggi University Hospital, ; Florence, Italy

[16 ]Department of Medical Sciences and Public Health, University of Cagliari, ( https://ror.org/003109y17) Cagliari, Italy

[17 ]Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität Zu Berlin, ( https://ror.org/001w7jn25) Hindenburgdamm 30, 12203 Berlin, Germany

[18 ]GRID grid.412507.5, ISNI 0000 0004 1773 5724, Anesthesia and Intensive Care Unit, Department of Surgery, , University Hospital “Gaetano Martino”, ; Messina, Italy

[19 ]Anesthesia and Resuscitation Unit, San Camillo-Forlanini Hospital, Sapienza University, ( https://ror.org/02be6w209) Rome, Italy

Author information

Andrea Cortegiani http://orcid.org/0000-0003-1416-9993

Article

Publisher ID: 126

DOI: 10.1186/s44158-023-00126-2

PMC ID: 10591347

PubMed ID: 37872608

SO-VID: 56e88d70-736e-4f3a-bf15-f1e4ea78fafd

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 28 June 2023

Date accepted : 10 October 2023

Custom metadata

Keywords: β-blockers,critically ill patient,icu,tachyarrhythmia,sepsis,adults

Data availability:

Keywords: β-blockers, critically ill patient, icu, tachyarrhythmia, sepsis, adults