Comparative Study between Ivabradine Versus Bisoprolol Effects for Heart Rate Control on Hemodynamics and Clinical Outcomes in Patients with Septic Shock
Journal of Advances in Medicine and Medical Research,
Background: Septic shock is associated with excessive sympathetic outflow, high plasma catecholamine levels, myocardial depression, vascular hypo-reactivity, and autonomic dysfunction. Typically, patients have a low resistance, high cardiac output circulation with tachycardia and arterial hypotension that may be poorly or even nonresponsive to exogenous catecholamine vasopressors. The aim of the present study was to compare the effect of ivabradine vs bisoprolol for heart rate control on the hemodynamics and clinical outcomes in patients with septic shock.
Methods: The study was carried out on 90 patients, aging from 18 to 60 years of both sex presented with septic shock in ICU. Patients were randomly classified into 3 equal groups each of 30 patients. Group I (Control group) received conventional therapy. Group II (Bisoprolol group) received conventional therapy plus bisoprolol 5 mg once daily & one placebo pill on 12 hrs interval via nasogastric tube for 7 days. Group III (Ivabradine group) received conventional therapy plus ivabradine 5 mg twice daily on 12 hrs interval via nasogastric tube for 7 days.
Results: Both bisoprolol and ivabradine effectively lowered heart rate in septic shock patients but ivabradine was more effective than bisoprolol. Both bisoprolol and ivabradine did not affect mean blood pressure, with ivabradine being more effective in maintaining blood pressure than bisoprolol. Noradrenaline dose was lower in ivabradine group in comparison with the other two groups. As regard to stroke volume & cardiac output, there was improvement in ivabradine group in comparison with bisoprolol and control groups. As regard to serum lactate level, there was improvement in ivabradine group in comparison with the other two groups. Both bisoprolol & ivabradine resulted in reduction in LOS & 28-day mortality with no significant difference between both groups.
Conclusions: Controlling heart rate in septic shock patients with either bisoprolol or ivabradine improves outcomes. Ivabradine is better than bisoprolol in maintaining hemodynamics and improving tissue perfusion parameters.
- clinical outcomes
- septic shock
How to Cite
Russell JA, Rush B, Boyd J. Pathophysiology of septic shock. Critical care clinics. 2018;34:43-61.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine. 2013;39:165-228.
Dünser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. Journal of intensive care medicine. 2009;24:293-316.
López-Sendó J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, et al. Expert consensus document on β-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology. European heart journal. 2004;25:1341-62.
De Santis V, Vitale D, Santoro A, Magliocca A, Porto AG, Nencini C, et al. Ivabradine: potential clinical applications in critically ill patients. Clinical Research in Cardiology. 2013;102:171-8.
Nuding S, Schröder J, Presek P, Wienke A, Müller-Werdan U, Ebelt H, et al. Reducing elevated heart rates in patients with multiple organ dysfunction syndrome with the if (funny channel current) inhibitor ivabradine. Shock. 2018;49:402-11.
Rajput RS, Das S, Chauhan S, Bisoi A, Vasdev S. Comparison of cardiac output measurement by noninvasive method with electrical cardiometry and invasive method with thermodilution technique in patients undergoing coronary artery bypass grafting. World Journal of Cardiovascular Surgery; 2014.
Zoremba N, Bickenbach J, Krauss B, Rossaint R, Kuhlen R, Schälte G. Comparison of electrical velocimetry and thermodilution techniques for the measurement of cardiac output. Acta Anaesthesiologica Scandinavica. 2007;51 :1314-9.
Schmidt C, Theilmeier G, Aken HV, Korsmeier P, Wirtz S, Berendes E, et al. Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output. British Journal of Anaesthesia. 2005;95:603-10.
Soliman R. Prediction of fluid status and survival by electrical cardiometry in septic patients with acute circulatory failure. The Egyptian Journal of Critical Care Medicine. 2017;5:65-8.
Cruz MC, Reis L. β-blockers in septic shock: are we there yet? Revista Brasileira de terapia intensiva. 2017;29:1.
de Montmollin E, Aboab J, Mansart A, Annane D. Bench-to-bedside review: β-adrenergic modulation in sepsis. Critical care. 2009;13:230.
Nuding S, Ebelt H, Hoke RS, Krummenerl A, Wienke A, Müller-Werdan U, et al. Reducing elevated heart rate in patients with multiple organ dysfunction syndrome by the I f (funny channel current) inhibitor ivabradine. Clinical Research in Cardiology. 2011;100:915.
Qiu S, Shi S, Ping H, Zhou S, Wang H, Yang B. Efficacy of ivabradine versus β-blockers for heart rate reduction during computed tomography coronary angiography: a meta-analysis of randomized controlled trials. Cardiology. 2016;135:133-40.
Ghadimi N, Kaveh S, Shabaninejad H, Lijassi A, Mehr AZ, Hosseinifard H. Comparative efficacy of ivabradine versus beta-blockers in patients with mitral stenosis in sinus rhythm: systematic review and meta-analysis. International journal of clinical pharmacy. 2019;41:22-9.
Ibrahim AN, Atallah RY. Ivabradine versus propranolol given orally in microlaryngoscopic surgeries in attenuating stress response: A comparative prospective double blind randomized study. Egyptian Journal of Anaesthesia. 2016;32:503-11.
Rimoldi SF, Messerli FH, Cerny D, Gloekler S, Traupe T, Laurent S, et al. Selective heart rate reduction with ivabradine increases central blood pressure in stable coronary artery disease. Hypertension. 2016;67:1205-10.
Morelli A, Ertmer C, Westphal M, Rehberg S, Kampmeier T, Ligges S, et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. Jama. 2013;310:1683-91.
Liu H, Ding X, Zhang S, Wang H, Luo Y, Duan X, et al. Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial. Zhonghua yi xue za zhi. 2019;99:1317-22.
De Santis V, Frati G, Greco E, Tritapepe L. Ivabradine: a preliminary observation for a new terapeutic role in patients with multiple organ dysfunction syndrome. Clinical Research in Cardiology. 2014;103:831-4.
Nguyen LS, Squara P, Amour J, Carbognani D, Bouabdallah K, Thierry S, et al. Intravenous ivabradine versus placebo in patients with low cardiac output syndrome treated by dobutamine after elective coronary artery bypass surgery: a phase 2 exploratory randomized controlled trial. Critical Care. 2018;22:193.
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Morelli A, Donati A, Ertmer C, Rehberg S, Kampmeier T, Orecchioni A, et al. Microvascular effects of heart rate control with esmolol in patients with septic shock: a pilot study. Critical Care Medicine. 2013;41:2162-8.
Schmittinger CA, Dünser MW, Haller M, Ulmer H, Luckner G, Torgersen C, et al. Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depression. Critical Care. 2008;12:R99.
Chen A, Elia N, Dunaiceva J, Rudiger A, Walder B, Pinto BB. Effect of ivabradine on major adverse cardiovascular events and mortality in critically ill patients: a systematic review and meta-analyses of randomised controlled trials with trial sequential analyses. British Journal of Anaesthesia; 2020.
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