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Randomized Controlled Trial
. 2010;14(6):R198.
doi: 10.1186/cc9317. Epub 2010 Nov 3.

Effect of oral β-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study

Markus Noveanu  1 , Tobias Breidthardt, Tobias Reichlin, Etienne Gayat, Mihael Potocki, Hans Pargger, Antje Heise, Julia Meissner, Raphael Twerenbold, Natalia Muravitskaya, Alexandre Mebazaa, Christian Mueller
Affiliations
Randomized Controlled Trial

Effect of oral β-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study

Markus Noveanu et al. Crit Care. 2010.

Abstract

Introduction: Acute respiratory failure (ARF) is responsible for about one-third of intensive care unit (ICU) admissions and is associated with adverse outcomes. Predictors of short- and long-term outcomes in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess the effects of oral beta-blockers in unselected ICU patients with ARF included in the BASEL-II-ICU study.

Methods: The BASEL II-ICU study was a prospective, multicenter, randomized, single-blinded, controlled trial of 314 (mean age 70 (62 to 79) years) ICU patients with ARF evaluating impact of a B-type natriuretic peptide- (BNP) guided management strategy on short-term outcomes.

Results: In-hospital mortality was 16% (51 patients) and one-year mortality 41% (128 patients). Multivariate analysis assessed that oral beta-blockers at admission were associated with a lower risk of both in-hospital (HR 0.33 (0.14 to 0.74) P = 0.007) and one-year mortality (HR 0.29 (0.16 to 0.51) P = 0.0003). Kaplan-Meier analysis confirmed the lower mortality in ARF patients when admitted with oral beta-blocker and further shows that the beneficial effect of oral beta-blockers at admission holds true in the two subgroups of patients with ARF related to cardiac or non-cardiac causes. Kaplan-Meier analysis also shows that administration of oral beta-blockers before hospital discharge gives striking additional beneficial effects on one-year mortality.

Conclusions: Established beta-blocker therapy appears to be associated with a reduced mortality in ICU patients with acute respiratory failure. Cessation of established therapy appears to be hazardous. Initiation of therapy prior to discharge appears to confer benefit. This finding was seen regardless of the cardiac or non-cardiac etiology of respiratory failure.

Trial registration: clinicalTrials.gov Identifier: NCT00130559.

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Figures

Figure 1
Figure 1
Impact of beta-blocker at admission on long-term outcome. Upper panel: Kaplan-Meier curve displaying overall one-year mortality in ICU patients with acute respiratory failure with or without treatment with beta-blocker at admission (P < 0.001 by Log Rank). Lower panel: Kaplan-Meier curve displaying one-year mortality with or without treatment with beta-blocker at admission in patients with cardiac aetiology of respiratory failure (adjudicated final diagnosis of heart failure; P = 0.008) and patients with non-cardiac aetiology of respiratory failure (adjudicated final diagnosis other than heart failure; P < 0.0001).
Figure 2
Figure 2
Progress of beta-blocker therapy during course of hospitalization. (admission, 24 hours and discharge n = 313).
Figure 3
Figure 3
Kaplan-Meier curve displaying mortality in patients with acute respiratory failure stratified by treatment with beta-blocker. Left Kaplan-Meier curve displaying overall long term mortality in all studied patients; middle: patients with cardiac aetiology of respiratory failure (adjudicated final diagnosis of heart failure); right: patients with non-cardiac etiology of respiratory failure.
See this image and copyright information in PMC

Comment in

References

    1. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342:1334–1349. doi: 10.1056/NEJM200005043421806. - DOI - PubMed
    1. Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Engl J Med. 2005;353:2788–2796. doi: 10.1056/NEJMcp052699. - DOI - PubMed
    1. Vincent JL, Akca S, De Mendonca A, Haji-Michael P, Sprung C, Moreno R, Antonelli M, Suter PM. The epidemiology of acute respiratory failure in critically ill patients(*) Chest. 2002;121:1602–1609. doi: 10.1378/chest.121.5.1602. - DOI - PubMed
    1. Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, Bonde J. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med. 1999;159:1849–1861. - PubMed
    1. Ray P, Birolleau S, Lefort Y, Becquemin MH, Beigelman C, Isnard R, Teixeira A, Arthaud M, Riou B, Boddaert J. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006;10:R82. doi: 10.1186/cc4926. - DOI - PMC - PubMed

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