Beta adrenergic system, over-activated in septic shock patients, is a key modulator of the inflammatory response. Experimental works demonstrated that Esmolol, an highly selective beta-1 blocker, reduces heart rate and regulates the inflammatory response. A recent mono centric, double blind, randomized clinical work in septic shock patients has shown that Esmolol administration is safe and reduces effectively heart rate. However there are only sparse data on 1) regional and micro-circulation, 2) inflammation modulation in human resuscitated septic shock patients treated by esmolol.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
After, at least six hours of hemodynamic optimization, patients with an hyper dynamic shock received a conventional management with a continuous infusion of Esmolol titrated to gain a 20% reduction in heart rate. This infusion is maintained for six hours.
CHU de Nancy
Nancy, France
RECRUITINGHemodynamic effects of Esmolol in septic shock patients (Value of cardiac index l/min/m2)
Compare, in septic shock patients, the mean cardiac index before and after administration of Esmolol.
Time frame: Before administration (H0) and each hour (H1-H2-H3-H4-H5-H6) during the whole administration period and one hour after Esmolol cessation (H7)
Effects on vasopressor requirement (amount of norepinephrine infused in microgram/kg) during Esmolol administration
Time frame: Record of each change in vasopressor dosage to maintain a mean arterial pressure at 70 mmHg during the whole Esmolol administration period (H0 to H6) and one hour after esmolol cessation (H7)
Microcirculatory and regional circulation effects of Esmolol in septic shock patient
NIRS (near-infrared spectroscopy) SDF (Sidestream Dark Field imaging) / Limon (non-invasive measurement of liver function and splanchnic perfusion monitoring) are used to asses microcirculatory and regional circulation effects
Time frame: Before (H0), 6 hours after Esmolol introduction (H6) and 1 hour after esmolol cessation (H7)
Changes in the Cytokine pattern(pro and anti inflammatory cytokines assay) induced by Esmolol administration in septic shock patients
Time frame: Before administration of Esmolol (H0) and 6 hours after introduction of Esmolol (H6)
Description of the cardiac function during Esmolol Administration in septic shock patients
Use of Echocardiography to assess ventricular function
Time frame: Before administration (H0), at 4 hours, 6 hours after introduction and 1 hours after esmolol cessation
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