Hemodynamic and metabolic effects of selective β1 adrenergic blockade during sepsis

Dennis Gore, Robert R. Wolfe

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

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 β1 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.

Original languageEnglish (US)
Pages (from-to)686-694
Number of pages9
JournalSurgery
Volume139
Issue number5
DOIs
StatePublished - May 2006

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Adrenergic Agents
Sepsis
Hemodynamics
Muscle Proteins
Heart Rate
Cardiac Output
Vascular Resistance
Thermodilution
Indirect Calorimetry
Adrenergic beta-Antagonists
Palmitates
Liver
Oxygen Consumption
Energy Metabolism
Pulmonary Artery
Leg
Pneumonia
Catheters
Adenosine Triphosphate
Oxygen

ASJC Scopus subject areas

  • Surgery

Cite this

Hemodynamic and metabolic effects of selective β1 adrenergic blockade during sepsis. / Gore, Dennis; Wolfe, Robert R.

In: Surgery, Vol. 139, No. 5, 05.2006, p. 686-694.

Research output: Contribution to journalArticle

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