Background
Selective beta adrenergic antagonists are commonly used to reduce myocardial demise
in patients at risk for cardiac-related death. The purpose of this study was to examine
the hemodynamic and metabolic effects of cardiac selective beta adrenergic blockade
in patients.
Methods
Muscle protein kinetics were quantified using isotopic tracer methodology in 6 moderately
septic, mechanically ventilated patients with pneumonia before and then at the conclusion
of a 3-hour infusion of esmolol of sufficient dose to reduce heart rate by 20% from
baseline. A battery of hemodynamic measurements as facilitated by a thermodilution
pulmonary artery catheter and indirect calorimetry were also measured before and after
the 3-hour selective beta adrenergic blockade.
Results
Selective beta adrenergic blockade was associated with the 20% reduction in heart
rate and a comparable decrease in cardiac output. Esmolol administration failed to
affect systemic or pulmonary vascular resistance, oxygen consumption, hepatic or leg
blood flow, energy expenditure, or ATP availability/energy charge within muscle. Esmolol
infuse did incite a shift in fuel oxidation toward an increase in palmitate oxidation
and with a decrease in the oxidation of glucose. There was no demonstrable influence
β1 adrenergic blockade on muscle protein kinetics.
Conclusions
Cardiac selective beta adrenergic blockade with esmolol reduces cardiac output in
proportion to the percentage decreases in heart rate in moderately severe septic patients
without adversely affecting oxygen utilization or hepatic, peripheral blood flow.
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Article info
Publication history
Accepted:
October 29,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
