Landiolol and Organ Failure in Patients With Septic Shock
SOFA score
DOI:
10.1001/jama.2023.20134
Publication Date:
2023-10-25T12:30:53Z
AUTHORS (479)
ABSTRACT
Importance Patients with septic shock undergo adrenergic stress, which affects cardiac, immune, inflammatory, and metabolic pathways. β-Blockade may attenuate the adverse effects of catecholamine exposure has been associated reduced mortality. Objectives To assess efficacy safety landiolol in patients tachycardia established requiring prolonged (>24 hours) vasopressor support. Design, Setting, Participants An open-label, multicenter, randomized trial involving 126 adults (≥18 years) (heart rate ≥95/min) treated for at least 24 hours continuous norepinephrine (≥0.1 μg/kg/min) 40 UK National Health Service intensive care units. The ran from April 2018 to December 2021, early termination 2021 due a signal possible harm. Intervention Sixty-three were receive standard 63 infusion. Main Outcomes Measures primary outcome was mean Sequential Organ Failure Assessment (SOFA) score randomization through 14 days. Secondary outcomes included mortality days 28 90 number events each group. Results stopped prematurely on advice independent data monitoring committee because it unlikely demonstrate benefit Of planned 340 participants, (37%) enrolled (mean age, 55.6 years [95% CI, 52.7 58.5 years]; 58.7% male). (SD) SOFA group 8.8 (3.9) compared 8.1 (3.2) difference [MD], 0.75 −0.49 2.0]; P = .24). Mortality day after 37.1% (23 62) 25.4% (16 63) (absolute difference, 11.7% −4.4% 27.8%]; .16). 43.5% (27 28.6% (18 15% −1.7% 31.6%]; .08). There no differences having one event. Conclusion Relevance Among more than hours, an infusion did not reduce organ failure measured by over randomization. These results do support use managing among shock. Trial Registration EU Clinical Trials Register Eudra CT: 2017-001785-14 ; isrctn.org Identifier: ISRCTN12600919
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