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Meta-Analysis
. 2024 Sep 12;24(1):326.
doi: 10.1186/s12871-024-02714-3.

The role of esmolol in sepsis: a meta-analysis based on randomized controlled trials

Ya Wei #  1 , Fengshan Bo #  2 , Jiakai Wang  1 , Jianyu Fu  1 , Yuyang Qiu  3 , Hongying Bi  1 , Dehua He  1 , Xu Liu  4
Affiliations
Meta-Analysis

The role of esmolol in sepsis: a meta-analysis based on randomized controlled trials

Ya Wei et al. BMC Anesthesiol. .

Abstract

Background: Sepsis is associated with a high incidence and mortality and poses a significant challenge to the treatment. Although esmolol has shown promise in sepsis treatment, its efficacy and safety remain contentious. This meta-analysis aims to clarify the role of esmolol in sepsis management.

Methods: PubMed, Embase, Web of Science, Cochrane library, clinicaltrials.gov and the Chinese Clinical Trial Registry were searched and references of relevant reviews and meta-analysis were also screened for appropriate studies. Keywords and free words of 'sepsis', 'esmolol' and 'randomized controlled trials' were used for search. Meta-analysis was performed using RevMan 5.3 software.

Results: Fifteen studies involving 1100 patients were included. Compared with the control group, patients receiving esmolol exhibited significantly decreased 28-day mortality (RR, 0.69; 95% CI, 0.60 to 0.81; P < 0.0001), heart rate (HR) (SMD, -1.15; 95% CI, -1.34 to -0.96; P < 0.0001), cardiac troponin I levels (cTnI) (SMD, -0.88; 95% CI, -1.13 to -0.64; P < 0.0001), length of intensive care unit (ICU) stay (SMD, -0.46; 95% CI, -0.62 to -0.3; P < 0.0001) and duration of mechanical ventilation (SMD, -0.28; 95% CI, -0.48 to -0.09; P = 0.004) and significantly increased central venous oxygen saturation (ScvO2) (SMD, 0.66; 95% CI, 0.44 to 0.88; P < 0.0001).While, esmolol had no significant influence on norepinephrine dosage (SMD, 0.08; 95% CI, -0.13 to 0.29; P = 0.46), mean arterial pressure (MAP) (SMD, 0.17; 95% CI, -0.07 to 0.4; P = 0.16), central venous pressure (CVP) (SMD, 0.16; 95% CI, -0.04 to 0.35; P = 0.11) and left ventricular ejection fraction (LVEF) (SMD, 0.21; 95% CI, -2.9 to 0.7; P = 0.41).

Conclusion: Esmolol reduces 28-day mortality, length of ICU stay and duration of mechanical ventilation in sepsis patients. Furthermore, esmolol improves oxygen metabolism, mitigates myocardial injury and decreases heart rate without significantly affecting hemodynamic parameters.

Trial registration: This study was registered on the PROSPERO website (registration number: CRD42023484884).

Keywords: Esmolol; Meta analysis; Randomized controlled trials; Sepsis; Septic shock.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the publication selection
Fig. 2
Fig. 2
Risk of bias summary for the included studies
Fig. 3
Fig. 3
A forest plot of 28-day mortality between the esmolol and control groups
Fig. 4
Fig. 4
A forest plot of cardiac troponin I levels between the esmolol and control groups
Fig. 5
Fig. 5
A forest plot of central venous oxygen saturation levels between the esmolol and control groups
Fig. 6
Fig. 6
A forest plot of the consumption of medical resources between the esmolol and control groups
See this image and copyright information in PMC

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