Septic Shock, Tachycardia, Mortality During Septic Shock, Beta-blocker
Conditions
Keywords
Septic Shock, Tachycardia, mortality during septic shock, beta-blocker
Brief summary
Several data emphasize the relation between tachycardia (\>90/min) and high mortality during septic shock. The investigators previously demonstrated the high mortality associated with hypercontractility, tachycardia and the presence of a left ventricular obstruction. A severe hypovolemia, a hyper adrenergic stimulation or a severe vasoplegia can all explain this relation between tachycardia, hypercontractility and the mortality during septic shock. Landiolol is another short-term acting beta-blocker with a half-life of 4 minutes without any beta 2 activity or membrane stabilizing effect. The landiolol has been used in critically ill patients to control supraventricular tachycardia but not in this context of tachycardia and septic shock. The investigators hypothesize that landiolol by reducing the heart rate may improve the survival of patients treated for a septic shock and presenting with an hypercontractility state.
Interventions
OTHERechocardiography
Full echocardiography will be performed at baseline and during the follow-up at H1, H3, H6 and H12.
DRUGLandiolol
Patients randomized to the experimental group will be treated according to the standard of care plus for 2 days with landiolol IV started at a dose of 1 microgram/kg/min and progressively increased every 10 minutes to a maximum of 40 micrograms/kg/min.
Sponsors
CH Dieppe
CH Elbeuf
CH Le Havre
Centre Hospitalier de Beauvais
CH Compiègne
CH Laon
University Hospital, Caen
CH Cherbourg
University Hospital, Lille
CH Douai
CH Montreuil
Centre Hospitalier de Roubaix
Centre Hospitalier de Bethune
CH Lomme
Centre Hospitalier de Lens
Tourcoing Hospital
Centre Hospitalier VALENCIENNES
Centre Hospitalier Arras
Hospital Ambroise Paré Paris
University Hospital, Brest
Henri Mondor University Hospital
Hospital Avicenne
University Hospital, Montpellier
CH Calais
Hôpital Edouard Herriot
Centre Hospitalier Universitaire de Nīmes
Groupe Hospitalier Pitié-Salpêtrière
Hôpital Louis Mourier, Colombes
Centre Hospitalier Universitaire, Amiens
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years old * Patient admitted for a septic shock (according to the SEPSIS3 definition: sepsis with persisting hypotension (MAP\<65mmHg or SAP \<90mmHg) requiring vasopressors to maintain MAP\>65mmHg and having a serum lactate level \>2 mmol/L * Patient who received at least 30ml/kg of fluid and absence of fluid responsiveness * Left ventricular ejection fraction \>65% (visual or Simpson method using echocardiography) * Tachycardia \>100 bpm in sinus rhythm with a MAP 65mmHg for more than 1 hour * Patient receiving invasive mechanical ventilation * Patients adapted to the ventilator under sedation and analgesia * Written informed consent * Patient covered by French national health insurance
Exclusion criteria
* Patients with inclusion criteria already present for more than 36 hours * Patient treated with Dobutamine, adrenaline or isoprenaline * Patient currently treated with beta blockers (previous home betablocker treatment is not an
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Variation of mortality rate in landiolol group compared to control group | day 28 |
Countries
France
Contacts
Primary ContactSlama Michel, Pr
Outcome results
None listed