The Latest in Critical Care, 11/27/23 (Issue #20)
Beta-blockers for septic shock? (STRESS-L), vitamin C for Covid-19, corporate takeover of medicine
Beta-blockers for septic shock (STRESS-L trial)
Septic shock deranges multiple complex signaling systems in the body. Complement pathways, the “inflammasome” (cytokines, et al), the coagulation cascade, and many, many more systems have been implicated, carefully mapped, with potential molecular targets identified for intervention. After more than 100 randomized trials, no effective therapy has yet resulted (drotecogin-alfa was withdrawn from the market after postmarketing testing showed no real benefits).
One pathway that still held promise: catecholamines, lifesaving when used as vasopressors (norepinephrine, epinephrine) but known to be toxic at high levels (causing organ stress and dysfunction, e.g. tako-tsubo cardiomyopathy).
A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third. One of those trials (Morelli et al) reported a 30…
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