Peran Terapi Penyekat Beta Pada Takikardia Persisten Yang Disebabkan Oleh Sepsis: Tinjauan Sistematis dan Meta-Analisis
Article Sidebar
Main Article Content
Abstract
Terdapat peningkatan minat dalam penggunaan penyekat beta untuk mengobati takikardia pada sepsis, namun umumnya penyekat beta relatif dikontraindikasikan untuk sepsis karena dapat menyebabkan penurunan aktivitas jantung. Tujuan dari penelitian ini adalah untuk mengetahui peran pengobatan penyekat beta pada pasien dengan takikardia persisten yang disebabkan oleh sepsis. Pencarian jurnal elektronik dilakukan di PubMed, ScienceDirect, dan Cochrane dari Januari 2013 hingga Mei 2023 untuk mengidentifikasi uji coba kontrol acak yang menilai peran pengobatan penyekat beta pada pasien dengan takikardia persisten yang disebabkan oleh sepsis. Penyekat beta yang dipilih pada penelitian ini adalah penyekat beta kerja pendek esmolol. Penggunaan penyekat beta pada pasien dengan takikardia persisten dan sepsis secara signifikan dikaitkan dengan rendahnya risiko semua penyebab kematian (P<0,0001; OR 0,42; 95%CI 0,27 - 0,65). Terdapat juga penurunan denyut jantung yang signifikan (P<0.00001; MD -18.34; 95%CI -25.62 - -11.06) dan peningkatan signifikan pada indeks volume sekuncup (P 0.01; MD 2.61; 95%CI 0.62 - 4.59) pada kelompok kelompok penyekat beta dibandingkan dengan kontrol. Beberapa penelitian lainnya melaporkan bahwa penurunan denyut jantung dengan esmolol secara efektif meningkatkan efisiensi kardiovaskular dengan menurunkan elastansi arteri statis dan meningkatkan volume sekuncup.
Article Details
References
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181–1247. https://doi.org/10.1007/s00134-021-06506-y
Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and Septic Shock – Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics of North America, 104(4), 573–585. https://doi.org/10.1016/j.mcna.2020.02.011
Geri, G., Vignon, P., Aubry, A., Fedou, A. L., Charron, C., Silva, S., Repessé, X., & Vieillard-Baron, A. (2019). Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Medicine. https://doi.org/10.1007/s00134-019-05596-z
Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Medicine, 7. https://doi.org/10.1177/2050312119835043
Jørgensen, L., Paludan-Müller, A. S., Laursen, D. R. T., Savović, J., Boutron, I., Sterne, J. A. C., Higgins, J. P. T., & Hróbjartsson, A. (2016). Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: Overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Systematic Reviews, 5(1), 1–13. https://doi.org/10.1186/s13643-016-0259-8
Kakihana, Y., Ito, T., Nakahara, M., Yamaguchi, K., & Yasuda, T. (2016). Sepsis-induced myocardial dysfunction: Pathophysiology and management. Journal of Intensive Care, 4(1), 1–10. https://doi.org/10.1186/s40560-016-0148-1
Khilnani, P. (2012). Severe sepsis and septic shock. ICU Protocols: A Stepwise Approach, 703–707. https://doi.org/10.1007/978-81-322-0535-7_88
Liu H, Ding XF, Z. S. (2019). Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial. Zhonghua Yi Xue Za Zhi, 99(17), 1317–1322.
Morelli, A., Ertmer, C., Westphal, M., Rehberg, S., Kampmeier, T., Ligges, S., Orecchioni, A., D’Egidio, A., D’Ippoliti, F., Raffone, C., Venditti, M., Guarracino, F., Girardis, M., Tritapepe, L., Pietropaoli, P., Mebazaa, A., & Singer, M. (2013). Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: A randomized clinical trial. Jama, 310(16), 1683–1691. https://doi.org/10.1001/jama.2013.278477
Morelli, A., Romano, S. M., Sanfilippo, F., Santonocito, C., Frati, G., Chiostri, M., Agrò, F. E., Ertmer, C., Rehberg, S. W., & Vieillard-Baron, A. (2020). Systolic-dicrotic notch pressure difference can identify tachycardic patients with septic shock at risk of cardiovascular decompensation following pharmacological heart rate reduction. British Journal of Anaesthesia, 125(6), 1018–1024. https://doi.org/10.1016/j.bja.2020.05.058
Morelli, A., Singer, M., Ranieri, V. M., D’Egidio, A., Mascia, L., Orecchioni, A., Piscioneri, F., Guarracino, F., Greco, E., Peruzzi, M., Biondi-Zoccai, G., Frati, G., & Romano, S. M. (2016). Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study. Intensive Care Medicine, 42(10), 1528–1534. https://doi.org/10.1007/s00134-016-4351-2
Nguyen, H. B., Jaehne, A. K., Jayaprakash, N., Semler, M. W., Hegab, S., Yataco, A. C., Tatem, G., Salem, D., Moore, S., Boka, K., Gill, J. K., Gardner-Gray, J., Pflaum, J., Domecq, J. P., Hurst, G., Belsky, J. B., Fowkes, R., Elkin, R. B., Simpson, S. Q., … Rivers, E. P. (2016). Early goal-directed therapy in severe sepsis and septic shock: Insights and comparisons to ProCESS, ProMISe, and ARISE. Critical Care, 20(1). https://doi.org/10.1186/s13054-016-1288-3
Sato, R., Ariyoshi, N., Hasegawa, D., Crossey, E., Hamahata, N., Ishihara, T., Nasu, M., & Devendra, G. (2021). Effects of Inotropes on the Mortality in Patients With Septic Shock. Journal of Intensive Care Medicine, 36(2), 211–219. https://doi.org/10.1177/0885066619892218
Singer, M., Deutschman, C. S., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., Poll, T. Der, Vincent, J. L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - Journal of the American Medical Association, 315(8), 801–810. https://doi.org/10.1001/jama.2016.0287
Suzuki, T., Suzuki, Y., Okuda, J., Kurazumi, T., Suhara, T., Ueda, T., Nagata, H., & Morisaki, H. (2017). Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis. Journal of Intensive Care, 5(1), 1–10. https://doi.org/10.1186/s40560-017-0215-2
Unger, M., Morelli, A., Singer, M., Radermacher, P., Rehberg, S., Trimmel, H., Joannidis, M., Heinz, G., Cerny, V., Dostál, P., Siebers, C., Guarracino, F., Pratesi, F., Biancofiore, G., Girardis, M., Kadlecova, P., Bouvet, O., Zörer, M., Grohmann-Izay, B., … Krumpl, G. (2018). Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): Study protocol for a randomized controlled trial. Trials, 19(1), 1–8. https://doi.org/10.1186/s13063-018-3024-6
Walkey, A. J., Hammill, B. G., Curtis, L. H., & Benjamin, E. J. (2014). Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest, 146(5), 1187–1195. https://doi.org/10.1378/chest.14-0003
Wang S, Li M, D. J. (2017). Effect of esmolol on hemodynamics and clinical outcomes in patients with septic shock. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 29(5), 390–395.
Wang, Z., Wu, Q., Nie, X., Guo, J., & Yang, C. (2015). Combination Therapy with Milrinone and Esmolol for Heart Protection in Patients with Severe Sepsis: A Prospective, Randomized Trial. Clinical Drug Investigation, 35(11), 707–716. https://doi.org/10.1007/s40261-015-0325-3
Yang S, Liu Z, Y. W. (2014). Effects of the beta-blockers on cardiac protection and hemodynamics in patients with septic shock: a prospective study. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 26(10), 714–717.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181–1247. https://doi.org/10.1007/s00134-021-06506-y
Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and Septic Shock – Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics of North America, 104(4), 573–585. https://doi.org/10.1016/j.mcna.2020.02.011
Geri, G., Vignon, P., Aubry, A., Fedou, A. L., Charron, C., Silva, S., Repessé, X., & Vieillard-Baron, A. (2019). Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Medicine. https://doi.org/10.1007/s00134-019-05596-z
Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Medicine, 7. https://doi.org/10.1177/2050312119835043
Jørgensen, L., Paludan-Müller, A. S., Laursen, D. R. T., Savović, J., Boutron, I., Sterne, J. A. C., Higgins, J. P. T., & Hróbjartsson, A. (2016). Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: Overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Systematic Reviews, 5(1), 1–13. https://doi.org/10.1186/s13643-016-0259-8
Kakihana, Y., Ito, T., Nakahara, M., Yamaguchi, K., & Yasuda, T. (2016). Sepsis-induced myocardial dysfunction: Pathophysiology and management. Journal of Intensive Care, 4(1), 1–10. https://doi.org/10.1186/s40560-016-0148-1
Khilnani, P. (2012). Severe sepsis and septic shock. ICU Protocols: A Stepwise Approach, 703–707. https://doi.org/10.1007/978-81-322-0535-7_88
Liu H, Ding XF, Z. S. (2019). Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial. Zhonghua Yi Xue Za Zhi, 99(17), 1317–1322.
Morelli, A., Ertmer, C., Westphal, M., Rehberg, S., Kampmeier, T., Ligges, S., Orecchioni, A., D’Egidio, A., D’Ippoliti, F., Raffone, C., Venditti, M., Guarracino, F., Girardis, M., Tritapepe, L., Pietropaoli, P., Mebazaa, A., & Singer, M. (2013). Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: A randomized clinical trial. Jama, 310(16), 1683–1691. https://doi.org/10.1001/jama.2013.278477
Morelli, A., Romano, S. M., Sanfilippo, F., Santonocito, C., Frati, G., Chiostri, M., Agrò, F. E., Ertmer, C., Rehberg, S. W., & Vieillard-Baron, A. (2020). Systolic-dicrotic notch pressure difference can identify tachycardic patients with septic shock at risk of cardiovascular decompensation following pharmacological heart rate reduction. British Journal of Anaesthesia, 125(6), 1018–1024. https://doi.org/10.1016/j.bja.2020.05.058
Morelli, A., Singer, M., Ranieri, V. M., D’Egidio, A., Mascia, L., Orecchioni, A., Piscioneri, F., Guarracino, F., Greco, E., Peruzzi, M., Biondi-Zoccai, G., Frati, G., & Romano, S. M. (2016). Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study. Intensive Care Medicine, 42(10), 1528–1534. https://doi.org/10.1007/s00134-016-4351-2
Nguyen, H. B., Jaehne, A. K., Jayaprakash, N., Semler, M. W., Hegab, S., Yataco, A. C., Tatem, G., Salem, D., Moore, S., Boka, K., Gill, J. K., Gardner-Gray, J., Pflaum, J., Domecq, J. P., Hurst, G., Belsky, J. B., Fowkes, R., Elkin, R. B., Simpson, S. Q., … Rivers, E. P. (2016). Early goal-directed therapy in severe sepsis and septic shock: Insights and comparisons to ProCESS, ProMISe, and ARISE. Critical Care, 20(1). https://doi.org/10.1186/s13054-016-1288-3
Sato, R., Ariyoshi, N., Hasegawa, D., Crossey, E., Hamahata, N., Ishihara, T., Nasu, M., & Devendra, G. (2021). Effects of Inotropes on the Mortality in Patients With Septic Shock. Journal of Intensive Care Medicine, 36(2), 211–219. https://doi.org/10.1177/0885066619892218
Singer, M., Deutschman, C. S., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., Poll, T. Der, Vincent, J. L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - Journal of the American Medical Association, 315(8), 801–810. https://doi.org/10.1001/jama.2016.0287
Suzuki, T., Suzuki, Y., Okuda, J., Kurazumi, T., Suhara, T., Ueda, T., Nagata, H., & Morisaki, H. (2017). Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis. Journal of Intensive Care, 5(1), 1–10. https://doi.org/10.1186/s40560-017-0215-2
Unger, M., Morelli, A., Singer, M., Radermacher, P., Rehberg, S., Trimmel, H., Joannidis, M., Heinz, G., Cerny, V., Dostál, P., Siebers, C., Guarracino, F., Pratesi, F., Biancofiore, G., Girardis, M., Kadlecova, P., Bouvet, O., Zörer, M., Grohmann-Izay, B., … Krumpl, G. (2018). Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): Study protocol for a randomized controlled trial. Trials, 19(1), 1–8. https://doi.org/10.1186/s13063-018-3024-6
Walkey, A. J., Hammill, B. G., Curtis, L. H., & Benjamin, E. J. (2014). Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest, 146(5), 1187–1195. https://doi.org/10.1378/chest.14-0003
Wang S, Li M, D. J. (2017). Effect of esmolol on hemodynamics and clinical outcomes in patients with septic shock. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 29(5), 390–395.
Wang, Z., Wu, Q., Nie, X., Guo, J., & Yang, C. (2015). Combination Therapy with Milrinone and Esmolol for Heart Protection in Patients with Severe Sepsis: A Prospective, Randomized Trial. Clinical Drug Investigation, 35(11), 707–716. https://doi.org/10.1007/s40261-015-0325-3
Yang S, Liu Z, Y. W. (2014). Effects of the beta-blockers on cardiac protection and hemodynamics in patients with septic shock: a prospective study. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 26(10), 714–717.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181–1247. https://doi.org/10.1007/s00134-021-06506-y
Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and Septic Shock – Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics of North America, 104(4), 573–585. https://doi.org/10.1016/j.mcna.2020.02.011
Geri, G., Vignon, P., Aubry, A., Fedou, A. L., Charron, C., Silva, S., Repessé, X., & Vieillard-Baron, A. (2019). Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Medicine. https://doi.org/10.1007/s00134-019-05596-z
Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Medicine, 7. https://doi.org/10.1177/2050312119835043
Jørgensen, L., Paludan-Müller, A. S., Laursen, D. R. T., Savović, J., Boutron, I., Sterne, J. A. C., Higgins, J. P. T., & Hróbjartsson, A. (2016). Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: Overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Systematic Reviews, 5(1), 1–13. https://doi.org/10.1186/s13643-016-0259-8
Kakihana, Y., Ito, T., Nakahara, M., Yamaguchi, K., & Yasuda, T. (2016). Sepsis-induced myocardial dysfunction: Pathophysiology and management. Journal of Intensive Care, 4(1), 1–10. https://doi.org/10.1186/s40560-016-0148-1
Khilnani, P. (2012). Severe sepsis and septic shock. ICU Protocols: A Stepwise Approach, 703–707. https://doi.org/10.1007/978-81-322-0535-7_88
Liu H, Ding XF, Z. S. (2019). Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial. Zhonghua Yi Xue Za Zhi, 99(17), 1317–1322.
Morelli, A., Ertmer, C., Westphal, M., Rehberg, S., Kampmeier, T., Ligges, S., Orecchioni, A., D’Egidio, A., D’Ippoliti, F., Raffone, C., Venditti, M., Guarracino, F., Girardis, M., Tritapepe, L., Pietropaoli, P., Mebazaa, A., & Singer, M. (2013). Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: A randomized clinical trial. Jama, 310(16), 1683–1691. https://doi.org/10.1001/jama.2013.278477
Morelli, A., Romano, S. M., Sanfilippo, F., Santonocito, C., Frati, G., Chiostri, M., Agrò, F. E., Ertmer, C., Rehberg, S. W., & Vieillard-Baron, A. (2020). Systolic-dicrotic notch pressure difference can identify tachycardic patients with septic shock at risk of cardiovascular decompensation following pharmacological heart rate reduction. British Journal of Anaesthesia, 125(6), 1018–1024. https://doi.org/10.1016/j.bja.2020.05.058
Morelli, A., Singer, M., Ranieri, V. M., D’Egidio, A., Mascia, L., Orecchioni, A., Piscioneri, F., Guarracino, F., Greco, E., Peruzzi, M., Biondi-Zoccai, G., Frati, G., & Romano, S. M. (2016). Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study. Intensive Care Medicine, 42(10), 1528–1534. https://doi.org/10.1007/s00134-016-4351-2
Nguyen, H. B., Jaehne, A. K., Jayaprakash, N., Semler, M. W., Hegab, S., Yataco, A. C., Tatem, G., Salem, D., Moore, S., Boka, K., Gill, J. K., Gardner-Gray, J., Pflaum, J., Domecq, J. P., Hurst, G., Belsky, J. B., Fowkes, R., Elkin, R. B., Simpson, S. Q., … Rivers, E. P. (2016). Early goal-directed therapy in severe sepsis and septic shock: Insights and comparisons to ProCESS, ProMISe, and ARISE. Critical Care, 20(1). https://doi.org/10.1186/s13054-016-1288-3
Sato, R., Ariyoshi, N., Hasegawa, D., Crossey, E., Hamahata, N., Ishihara, T., Nasu, M., & Devendra, G. (2021). Effects of Inotropes on the Mortality in Patients With Septic Shock. Journal of Intensive Care Medicine, 36(2), 211–219. https://doi.org/10.1177/0885066619892218
Singer, M., Deutschman, C. S., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., Poll, T. Der, Vincent, J. L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - Journal of the American Medical Association, 315(8), 801–810. https://doi.org/10.1001/jama.2016.0287
Suzuki, T., Suzuki, Y., Okuda, J., Kurazumi, T., Suhara, T., Ueda, T., Nagata, H., & Morisaki, H. (2017). Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis. Journal of Intensive Care, 5(1), 1–10. https://doi.org/10.1186/s40560-017-0215-2
Unger, M., Morelli, A., Singer, M., Radermacher, P., Rehberg, S., Trimmel, H., Joannidis, M., Heinz, G., Cerny, V., Dostál, P., Siebers, C., Guarracino, F., Pratesi, F., Biancofiore, G., Girardis, M., Kadlecova, P., Bouvet, O., Zörer, M., Grohmann-Izay, B., … Krumpl, G. (2018). Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): Study protocol for a randomized controlled trial. Trials, 19(1), 1–8. https://doi.org/10.1186/s13063-018-3024-6
Walkey, A. J., Hammill, B. G., Curtis, L. H., & Benjamin, E. J. (2014). Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest, 146(5), 1187–1195. https://doi.org/10.1378/chest.14-0003
Wang S, Li M, D. J. (2017). Effect of esmolol on hemodynamics and clinical outcomes in patients with septic shock. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 29(5), 390–395.
Wang, Z., Wu, Q., Nie, X., Guo, J., & Yang, C. (2015). Combination Therapy with Milrinone and Esmolol for Heart Protection in Patients with Severe Sepsis: A Prospective, Randomized Trial. Clinical Drug Investigation, 35(11), 707–716. https://doi.org/10.1007/s40261-015-0325-3
Yang S, Liu Z, Y. W. (2014). Effects of the beta-blockers on cardiac protection and hemodynamics in patients with septic shock: a prospective study. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 26(10), 714–717.