Lars Mølgaard Saxhaug
@load-dependent.eurosky.social
5.7K followers 5.2K following 9.4K posts
Cardiologist @ St. Olavs hospital | #POCUS research @ NTNU| #Echo | #CriticalCare | #Physiology | #Equity | #SDH | #Statistics | #Rstats | #MedSky | #CardioSky | #CCCSky | #emimcc | Trondheim MDG💚 |🇳🇴🇩🇰 Trondheim, Norway | he/him/han/ham|
![What is known
Tachycardia is a feature of compensatory sympathetic stimulation (9, 10]. Sustained non-compensatory tachycardia may impair diastolic function, increase myocardial workload, and worsen ventriculo-arterial coupling [12-14). The potential to attenuate adrenergic toxicity while simultaneously allowing a compensatory adr-energic response has generated interest in the role of B-blockers. However, clinical studies have produced conflicting results [15-21]. In two multicentre randomised controlled trials (RTs) in septic shock, landiolol was associated with either an increased norepinephrine requirement and mortality (STRESS-L) [20] or no significant difference in vasopressor dose or mortality (Landi-SEP) [18]. These findings contrast with single-centre studies in which esmolol therapy was associated with reduced catecholamine requirements, fewer episodes of tachyarrhythmias, and improved mortality despite a significantly greater reduction in systemic oxygen delivery compared to the control group [21].
A limitation in some multicentre studies may have been the limited use of advanced hemodynamic monitoring capable of identifying clinically significant reductions in cardiac output and oxygen delivery after heart rate reduction [21, 22]. Moreover, a reduction of myocardial contractility may occur, but can pass undetected by conventional echocardiographic parameters 22).](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:wl5zwdwkg4kqg25gtxbepfh4/bafkreieqzwz264c7xezcqtlkgkuxmmenw4wearv2irat7qacpvk5kw36ha)
