Document Detail


Hemodynamic and metabolic effects of selective beta1 adrenergic blockade during sepsis.
MedLine Citation:
PMID:  16701103     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Selective beta adrenergic antagonists are commonly used to reduce myocardial demise in patients at risk for cardiac-related death. The purpose of this study was to examine the hemodynamic and metabolic effects of cardiac selective beta adrenergic blockade in patients. METHODS: Muscle protein kinetics were quantified using isotopic tracer methodology in 6 moderately septic, mechanically ventilated patients with pneumonia before and then at the conclusion of a 3-hour infusion of esmolol of sufficient dose to reduce heart rate by 20% from baseline. A battery of hemodynamic measurements as facilitated by a thermodilution pulmonary artery catheter and indirect calorimetry were also measured before and after the 3-hour selective beta adrenergic blockade. RESULTS: Selective beta adrenergic blockade was associated with the 20% reduction in heart rate and a comparable decrease in cardiac output. Esmolol administration failed to affect systemic or pulmonary vascular resistance, oxygen consumption, hepatic or leg blood flow, energy expenditure, or ATP availability/energy charge within muscle. Esmolol infuse did incite a shift in fuel oxidation toward an increase in palmitate oxidation and with a decrease in the oxidation of glucose. There was no demonstrable influence beta1 adrenergic blockade on muscle protein kinetics. CONCLUSIONS: Cardiac selective beta adrenergic blockade with esmolol reduces cardiac output in proportion to the percentage decreases in heart rate in moderately severe septic patients without adversely affecting oxygen utilization or hepatic, peripheral blood flow.
Authors:
Dennis C Gore; Robert R Wolfe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  139     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-16     Completed Date:  2006-06-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  686-94     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77555, USA. dcgore@utmb.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adrenergic beta-Antagonists / therapeutic use*
Adult
Body Surface Area
Calorimetry, Indirect
Cardiac Output / drug effects*
Creatinine / blood
Heart Rate / drug effects*
Hemodynamics / drug effects*
Hemoglobins / metabolism*
Humans
Lung Compliance / drug effects*
Middle Aged
Oxygen / blood
Propanolamines / therapeutic use*
Receptors, Adrenergic, beta-1 / antagonists & inhibitors*
Sepsis / blood,  drug therapy,  physiopathology*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Hemoglobins; 0/Propanolamines; 0/Receptors, Adrenergic, beta-1; 60-27-5/Creatinine; 7782-44-7/Oxygen; 84057-94-3/esmolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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