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Background <p>Sepsis 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.</p> Methods <p>This 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&#xa0;h, and 48&#xa0;h. Oxygenation/tissue perfusion markers and disease severity scores were assessed at baseline and 48&#xa0;h. Clinical outcomes included 28-day mortality, ICU, and hospital length of stay.</p> Results <p>A 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&#xa0;h, <i>p</i> = 0.002) and systemic vascular resistance index (163.31 vs. 180.95 at 48&#xa0;h, <i>p</i> &lt; 0.001), and higher cardiac index (3.66 vs. 3.34 at 48&#xa0;h, <i>p</i> &lt; 0.001). The NEC group also had higher post-treatment ScvO₂ (79.08% vs. 75.82%, <i>p</i> = 0.001) and lower lactate (1.68 vs. 1.93, <i>p</i> &lt; 0.001). SOFA and APACHE II scores improved more in the NEC group (<i>p</i> &lt; 0.001). The 28-day mortality was significantly lower in the NEC group (7.81% vs. 23.39%, <i>p</i> &lt; 0.001).</p> Conclusion <p>Early 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.</p> Clinical trial number <p>Not applicable</p>

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Effects of early use of norepinephrine combined with esmolol on hemodynamic stability and 28-day mortality in patients with septic shock

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月24日

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  • Huifang Cai,
  • Lingmin Yuan,
  • Qin Yang

摘要

Background

Sepsis 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.

Methods

This 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.

Results

A 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).

Conclusion

Early 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