Beta-blockers in septic shock to optimize hemodynamics? No

Excerpt

Cardiac assessment in the critically ill septic patient has become increasingly sophisticated [1]; yet, the relationship between the heart and systemic arterial system remains an area of unfulfilled hope, with precise evaluation continuing to elude the practicing clinician. The concept of “cardiovascular (CV) performance or efficiency” is an attractive one, a tool promising to bridge the knowledge gulf that currently exists [2]. That said, its clinical application is challenging. First, there seems to be a lack of consensus as to which parameters best represent CV performance, whether it be stroke volume (SV), stroke work (SW), work efficiency, or the ventriculo arterial coupling (V-A coupling) [3]. Second, pragmatic methods for measuring some theoretical parameters, such as unstressed ventricular volume (V ₀), end-systolic pressure (P _es), and arterial compliance (C _art), are still lacking, let alone the challenge of the time-variable nature of these parameters. …