Evidence map›Paper›PMID 27101380›Full record

Observational studyIntensive care medicine2016

Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study.

A Morelli, M Singer, V M Ranieri, A D'Egidio, L Mascia, A Orecchioni, F Piscioneri, F Guarracino, E Greco, M Peruzzi and 3 more

Registry-linked trialAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04388267 (Comparative Study on the Relationship Between Fluid REsponsiveness and Arterial ELASTANCE in Patients With Septic Shock or in the Postoperative Course of Aortic Surgery), which is not on this map. Cited by 61 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 1 pooled it
15.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04388267 unknown statusnot on this mapstarted 2019, after this paper: background citation

Comparative Study on the Relationship Between Fluid REsponsiveness and Arterial ELASTANCE in Patients With Septic Shock or in the Postoperative Course of Aortic Surgery

TypeobservationalSponsorCentral Hospital, Nancy, FranceRan2019 to 2020Enrolled80ConditionsShock, Septic, Hyperlactatemia, Oliguria, Aortic Aneurysm, AbdominalArmsFluid challenge
3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 1 synthesis or guideline pooled it, 122 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. [Septic cardiomyopathy-diagnosis and estimation of disease severity].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
    Review
  10. Review
  11. Article
  12. Article
  13. Ivabradine in Septic Shock: A Narrative Review.Journal of clinical medicine · 2024
    Review
  14. Article
  15. Article
  16. Article
  17. Article
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1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 2 countries.

A MorelliDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico 155, 00161, Rome, Italy. andrea.morelli@uniroma1.it.
M SingerBloomsbury Institute of Intensive Care Medicine, University College London, Cruciform Building, London, WC1E 6BT, UK.
V M RanieriDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico 155, 00161, Rome, Italy.
A D'EgidioDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico 155, 00161, Rome, Italy.
L MasciaDepartment of Medico-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Corso della Repubblica, 79, 04100, Latina, Italy.
A OrecchioniDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico 155, 00161, Rome, Italy.
F PiscioneriDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico 155, 00161, Rome, Italy.
F GuarracinoDepartment of Anesthesia and Intensive Care, Cardiothoracic Anesthesia and Intensive Care Medicine, University Hospital of Pisa, via Roma 55, 56126, Pisa, Italy.
E GrecoDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico 155, 00161, Rome, Italy.
M PeruzziDepartment of Medico-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Corso della Repubblica, 79, 04100, Latina, Italy.
G Biondi-ZoccaiDepartment of Medico-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Corso della Repubblica, 79, 04100, Latina, Italy.
G FratiDepartment of Medico-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Corso della Repubblica, 79, 04100, Latina, Italy.
S M RomanoUnit of Internal Medicine and Cardiology, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
Policlinico Umberto I · ITSapienza University of Rome · ITAzienda Ospedaliera Universitaria Pisana · ITBury College · GBIstituto Neurologico Mediterraneo · ITUniversity of Florence · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeVentricular-arterial (V-A) decoupling decreases myocardial efficiency and is exacerbated by tachycardia that increases static arterial elastance (Ea). We thus investigated the effects of heart rate (HR) reduction on Ea in septic shock patients using the beta-blocker esmolol. We hypothesized that esmolol improves Ea by positively affecting the tone of arterial vessels and their responsiveness to HR-related changes in stroke volume (SV).

methodsAfter at least 24 h of hemodynamic optimization, 45 septic shock patients, with an HR ≥95 bpm and requiring norepinephrine to maintain mean arterial pressure (MAP) ≥65 mmHg, received a titrated esmolol infusion to maintain HR between 80 and 94 bpm. Ea was calculated as MAP/SV. All measurements, including data from right heart catheterization, echocardiography, arterial waveform analysis, and norepinephrine requirements, were obtained at baseline and at 4 h after commencing esmolol.

resultsEsmolol reduced HR in all patients and this was associated with a decrease in Ea (2.19 ± 0.77 vs. 1.72 ± 0.52 mmHg l(-1)), arterial dP/dt max (1.08 ± 0.32 vs. 0.89 ± 0.29 mmHg ms(-1)), and a parallel increase in SV (48 ± 14 vs. 59 ± 18 ml), all p < 0.05. Cardiac output and ejection fraction remained unchanged, whereas norepinephrine requirements were reduced (0.7 ± 0.7 to 0.58 ± 0.5 µg kg(-1) min(-1), p < 0.05).

conclusionsHR reduction with esmolol effectively improved Ea while allowing adequate systemic perfusion in patients with severe septic shock who remained tachycardic despite standard volume resuscitation. As Ea is a major determinant of V-A coupling, its reduction may contribute to improving cardiovascular efficiency in septic shock.

Indexed as

Adrenergic beta-1 Receptor AntagonistsAdultAgedEchocardiographyFemaleHeart RateHemodynamicsHumansMaleMiddle AgedNorepinephrinePropanolaminesProspective StudiesPulmonary ArteryShock, SepticStroke VolumeAdrenergic beta-1 Receptor AntagonistsesmololNorepinephrinePropanolaminesVasoconstrictor AgentsArterial elastanceBeta-adrenergic receptorsDicrotic notchHeart rateSeptic shockTachycardiaVentricular-arterial coupling

Identifiers

PMID27101380
OpenAlexW2341870648

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.