β-Blockers in Patients With Sepsis: Putting the Puzzle Together, Piece by Piece

Challenging conventional wisdom is important and frequently useful. Septic shock is a form of distributive shock in which hypotension results from vasodilation. Although myocardial performance may not always be entirely normal, a phenomenon termed septic cardiomyopathy cardiac output is usually preserved, in part by increased heart rate. Therapy of septic shock refractory to fluid administration entails administration of vasopressor agents; norepinephrine is generally preferred as an initial agent. In those cases in which cardiac output is felt to be low enough to compromise perfusion, inotropic agents may be used. In this context, use of β-blockers may well be regarded as counterintuitive inasmuch as their hemodynamic effects would tend to decrease arterial pressure and cardiac output. Despite this, investigators have challenged conventional wisdom and evaluated the effects of β-blockade for treating sepsis.