Impact of Short-Acting Beta-Blockers on the Outcomes of Patients With Septic Shock: A Systematic Review and Meta-Analysis.

Summary

Across 12 RCTs (n=1170), short-acting beta-blockers were associated with lower 28-day mortality (RR 0.76, low certainty) and fewer new tachyarrhythmias (RR 0.37, moderate certainty), but possibly longer vasopressor duration (+1.04 days). Effects on 90-day mortality and resource use were uncertain with very low certainty evidence.

Key Findings

• Meta-analysis of 12 RCTs (n=1170) showed reduced 28-day mortality with short-acting beta-blockers (RR 0.76; 95% CI 0.62–0.93; low certainty).
• New-onset tachyarrhythmias were probably reduced (RR 0.37; 95% CI 0.18–0.78; moderate certainty).
• Vasopressor duration may be increased (MD +1.04 days; 95% CI 0.37–1.72; low certainty); effects on 90-day mortality and lengths of stay were uncertain.

Clinical Implications

Clinicians may consider short-acting beta-blockade to control persistent tachycardia in stabilized septic shock with careful monitoring for hypotension/bradycardia and acknowledging potential extension of vasopressor use; routine adoption awaits larger high-quality RCTs.

Limitations

• Overall low certainty due to small sample sizes, heterogeneity, and imprecision across trials.
• Safety outcomes and long-term mortality effects remain uncertain; potential publication bias.

Future Directions

Large, multicenter, CONSORT-compliant RCTs with standardized protocols (dose, initiation timing) to test mortality, arrhythmia control, vasopressor-sparing, and safety in predefined phenotypes.