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

Adults Critically ill patient ICU Sepsis Tachyarrhythmia β-blockers

Journal

Journal of anesthesia, analgesia and critical care
ISSN: 2731-3786
Titre abrégé: J Anesth Analg Crit Care
Pays: England
ID NLM: 9918591885906676

Informations de publication

Date de publication:
23 Oct 2023
Historique:
received: 28 06 2023
accepted: 10 10 2023
medline: 24 10 2023
pubmed: 24 10 2023
entrez: 23 10 2023
Statut: epublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1186/s44158-023-00126-2 PMID: 37872608 PMC: PMC10591347
pubmed: 37872608
doi: 10.1186/s44158-023-00126-2
pii: 10.1186/s44158-023-00126-2
pmc: PMC10591347
doi:

Types de publication

Journal Article

Langues

eng

Pagination

41

Informations de copyright

© 2023. Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care.

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Auteurs

Fabio Guarracino (F)

Cardiothoracic and Vascular Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Andrea Cortegiani (A)

Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy. andrea.cortegiani@unipa.it.
Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127, Palermo, Italy. andrea.cortegiani@unipa.it.
ORCID: 0000-0003-1416-9993

Massimo Antonelli (M)

Department of Emergency, Anesthesiological and Resuscitation Sciences, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Astrid Behr (A)

Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy.

Giandomenico Biancofiore (G)

Anesthesia and Resuscitation Transplants, Department of Medical Pathology Surgical, Molecular and Critical Area, University of Pisa, Pisa, Italy.

Alfredo Del Gaudio (A)

Emergency Department, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.

Francesco Forfori (F)

Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Nicola Galdieri (N)

General Cardiac Surgery Unit, Critical Area Department, Ospedale Dei Colli, Naples, Italy.

Giacomo Grasselli (G)

Department of Anesthesia, Resuscitation and Emergency, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy.

Gianluca Paternoster (G)

Cardiovascular Anesthesia and ICU, San Carlo Hospital, Potenza, Italy.

Monica Rocco (M)

Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, Rome, Italy.

Stefano Romagnoli (S)

Anesthesia and Intensive Care Section, Department of Health Sciences, University of Florence, Florence, Italy.
Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.

Salvatore Sardo (S)

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.

Sascha Treskatsch (S)

Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.

Vincenzo Francesco Tripodi (VF)

Anesthesia and Intensive Care Unit, Department of Surgery, University Hospital "Gaetano Martino", Messina, Italy.

Luigi Tritapepe (L)

Anesthesia and Resuscitation Unit, San Camillo-Forlanini Hospital, Sapienza University, Rome, Italy.

Classifications MeSH