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Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis

Despite recent advances in medical care, mortality due to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, remains high. Fluid resuscitation and vasopressors are the first-line treatment for sepsis in order to optimize hemodynamic instability...

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Autores principales: Suzuki, Takeshi, Suzuki, Yuta, Okuda, Jun, Kurazumi, Takuya, Suhara, Tomohiro, Ueda, Tomomi, Nagata, Hiromasa, Morisaki, Hiroshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335779/
https://www.ncbi.nlm.nih.gov/pubmed/28270914
http://dx.doi.org/10.1186/s40560-017-0215-2
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author Suzuki, Takeshi
Suzuki, Yuta
Okuda, Jun
Kurazumi, Takuya
Suhara, Tomohiro
Ueda, Tomomi
Nagata, Hiromasa
Morisaki, Hiroshi
author_facet Suzuki, Takeshi
Suzuki, Yuta
Okuda, Jun
Kurazumi, Takuya
Suhara, Tomohiro
Ueda, Tomomi
Nagata, Hiromasa
Morisaki, Hiroshi
author_sort Suzuki, Takeshi
collection PubMed
description Despite recent advances in medical care, mortality due to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, remains high. Fluid resuscitation and vasopressors are the first-line treatment for sepsis in order to optimize hemodynamic instability caused by vasodilation and increased vascular permeability. However, these therapies, aimed at maintaining blood pressure and blood flow to vital organs, could have deleterious cardiac effects, as cardiomyocyte damage occurs in the early stages of sepsis. Recent experimental and clinical studies have demonstrated that a number of factors contribute to sepsis-induced cardiac dysfunction and the degree of cardiac dysfunction is one of the major prognostic factors of sepsis. Therefore, strategies to prevent further cardiomyocyte damage could be of crucial importance in improving the outcome of sepsis. Among many factors causing sepsis-induced cardiac dysfunction, sympathetic nerve overstimulation, due to endogenous elevated catecholamine levels and exogenous catecholamine administration, is thought to play a major role. β-adrenergic blockade therapy is widely used for ischemic heart disease and chronic heart failure and in the prevention of cardiovascular events in high-risk perioperative patients undergoing major surgery. It has also been shown to restore cardiac function in experimental septic animal models. In a single-center randomized controlled trial, esmolol infusion in patients with septic shock with persistent tachycardia reduced the 28-day mortality. Furthermore, it is likely that β-adrenergic blockade therapy may result in further beneficial effects in patients with sepsis, such as the reduction of inflammatory cytokine production, suppression of hypermetabolic status, maintenance of glucose homeostasis, and improvement of coagulation disorders. Recent accumulating evidence suggests that β-adrenergic blockade could be an attractive therapy to improve the prognosis of sepsis. We await a large multicenter randomized clinical trial to confirm the beneficial effects of β-adrenergic blockade therapy in sepsis, of which mortality is still high.
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spelling pubmed-53357792017-03-07 Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis Suzuki, Takeshi Suzuki, Yuta Okuda, Jun Kurazumi, Takuya Suhara, Tomohiro Ueda, Tomomi Nagata, Hiromasa Morisaki, Hiroshi J Intensive Care Review Despite recent advances in medical care, mortality due to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, remains high. Fluid resuscitation and vasopressors are the first-line treatment for sepsis in order to optimize hemodynamic instability caused by vasodilation and increased vascular permeability. However, these therapies, aimed at maintaining blood pressure and blood flow to vital organs, could have deleterious cardiac effects, as cardiomyocyte damage occurs in the early stages of sepsis. Recent experimental and clinical studies have demonstrated that a number of factors contribute to sepsis-induced cardiac dysfunction and the degree of cardiac dysfunction is one of the major prognostic factors of sepsis. Therefore, strategies to prevent further cardiomyocyte damage could be of crucial importance in improving the outcome of sepsis. Among many factors causing sepsis-induced cardiac dysfunction, sympathetic nerve overstimulation, due to endogenous elevated catecholamine levels and exogenous catecholamine administration, is thought to play a major role. β-adrenergic blockade therapy is widely used for ischemic heart disease and chronic heart failure and in the prevention of cardiovascular events in high-risk perioperative patients undergoing major surgery. It has also been shown to restore cardiac function in experimental septic animal models. In a single-center randomized controlled trial, esmolol infusion in patients with septic shock with persistent tachycardia reduced the 28-day mortality. Furthermore, it is likely that β-adrenergic blockade therapy may result in further beneficial effects in patients with sepsis, such as the reduction of inflammatory cytokine production, suppression of hypermetabolic status, maintenance of glucose homeostasis, and improvement of coagulation disorders. Recent accumulating evidence suggests that β-adrenergic blockade could be an attractive therapy to improve the prognosis of sepsis. We await a large multicenter randomized clinical trial to confirm the beneficial effects of β-adrenergic blockade therapy in sepsis, of which mortality is still high. BioMed Central 2017-03-03 /pmc/articles/PMC5335779/ /pubmed/28270914 http://dx.doi.org/10.1186/s40560-017-0215-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Suzuki, Takeshi
Suzuki, Yuta
Okuda, Jun
Kurazumi, Takuya
Suhara, Tomohiro
Ueda, Tomomi
Nagata, Hiromasa
Morisaki, Hiroshi
Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
title Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
title_full Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
title_fullStr Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
title_full_unstemmed Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
title_short Sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
title_sort sepsis-induced cardiac dysfunction and β-adrenergic blockade therapy for sepsis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335779/
https://www.ncbi.nlm.nih.gov/pubmed/28270914
http://dx.doi.org/10.1186/s40560-017-0215-2
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