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β-blockade in sepsis: regulation of persisting sepsis-related tachycardia.
The Lancet Respiratory Medicine ( IF 38.7 ) Pub Date : 2020-03-31 , DOI: 10.1016/s2213-2600(20)30063-1
Andrea Morelli 1 , Tony Whitehouse 2 , Sebastian Rehberg 3
Affiliation  

There is a sense of fatigue within the critical care community at the number of large, well run, interventional sepsis trials aimed at improving systemic haemodynamics that have not shown statistical separation between control and intervention groups. Nevertheless, post-hoc analyses of larger trials indicate that some subgroups of patients could benefit from cardiovascular intervention; with the implication that just as many may have come to harm by the same intervention. It is with this background that intensive care unit (ICU) clinicians have begun to realise the need to identify subgroups within a septic cohort. In some patients, protracted endogenous and exogenous sympathetic overstimulation, marked by persisting tachycardia, has been shown to be harmful despite initial improvement in haemodynamic response. In this context, the duration as well as the total dose of catecholamine therapy and the detrimental effects of tachycardia are associated with poor outcomes. Targeting such patients might present a phenotypic or genetic subgroup with an especially poor prognosis out of the heterogenous septic population.

中文翻译:

脓毒症中的β受体阻滞:调节与脓毒症相关的持续性心动过速。

在重症监护社区中,大量旨在改善系统血流动力学的,运转良好的败血症试验的数量令人感到疲倦,但并未显示对照组和干预组之间的统计分离。然而,对大型试验的事后分析表明,某些亚组的患者可以从心血管干预中受益;然而,在某些情况下,这些亚组可能会受益。暗示着同样的干预可能会伤害到同样多的人。正是在这种背景下,重症监护病房(ICU)临床医生开始意识到需要确定败血症队列中的亚组。在某些患者中,以持久的心动过速为特征的持续的内源性和外源性交感神经过度刺激,尽管血液动力学反应已得到初步改善,但已被证明是有害的。在这种情况下,, 针对此类患者,可能存在异型败血病患者中表现特别差的表型或遗传亚组。
更新日期:2020-04-01
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