ArticleBMC infectious diseases2026
Effects of early use of norepinephrine combined with esmolol on hemodynamic stability and 28-day mortality in patients with septic shock.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSepsis and septic shock are leading causes of intensive care unit (ICU) mortality, with persistent high mortality despite standard care including norepinephrine. This study aimed to investigate whether early combination therapy with norepinephrine and esmolol improves hemodynamics and 28-day survival in septic shock patients.
methodsThis retrospective cohort study enrolled patients with septic shock between June 2020 and June 2023. Patients were divided into a norepinephrine only (NEO) group and a norepinephrine plus esmolol (NEC) group. Hemodynamic parameters were monitored at baseline, 24 h, and 48 h. Oxygenation/tissue perfusion markers and disease severity scores were assessed at baseline and 48 h. Clinical outcomes included 28-day mortality, ICU, and hospital length of stay.
resultsA total of 252 patients were analyzed (NEO = 124, NEC = 128). Compared to the NEO group, the NEC group showed significantly lower heart rate (93.42 vs. 96.15 at 48 h, p = 0.002) and systemic vascular resistance index (163.31 vs. 180.95 at 48 h, p < 0.001), and higher cardiac index (3.66 vs. 3.34 at 48 h, p < 0.001). The NEC group also had higher post-treatment ScvO₂ (79.08% vs. 75.82%, p = 0.001) and lower lactate (1.68 vs. 1.93, p < 0.001). SOFA and APACHE II scores improved more in the NEC group (p < 0.001). The 28-day mortality was significantly lower in the NEC group (7.81% vs. 23.39%, p < 0.001).
conclusionEarly combined use of norepinephrine and esmolol was associated with improved hemodynamic stability, enhanced tissue perfusion, accelerated organ function recovery, and reduced 28-day mortality in patients with septic shock. CLINICAL TRIAL NUMBER: Not applicable.
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