Beta-blockade in septic shock: A paradigm shift in management?

Beta-blockers have been extensively studied and benefit patients in many aspects of cardiology such as hypertension, ischemic heart disease, and chronic heart failure. Improved cardiac efficiency, suppression of dysrhythmias, and improved peripheral vascular profile have all been proposed as mechanisms, but recent evidence has suggested that some of their benefits may be attributed to the attenuation of inflammation. The finding from a single center study, which reported a dramatic decrease in mortality by the introduction of β-blockade to a subgroup of patients with septic shock, may have derived its success from modification of the immune response. The renewed interest in β-blockade comes at a time when extensive research into mechanisms of sepsis has failed to deliver a viable and reliable treatment that alters the course of the disease. In this chapter, we review the role of the adrenergic system in sepsis and septic shock through evidence from animal models and discuss what place, if any, they should play in treating critically ill septic patients.