A Clinical Syndrome

1974 Words Sep 3rd, 2014 8 Pages
Introduction
Sepsis is a clinical syndrome that arises from inflammatory response to infection. The response from the host is associated with immune, hormonal, metabolic, bioenergetic and autonomic nervous system modification. This is associated with an overall catabolic state, excessive adrenergic stimulation, high catecholamine levels and myocardial depression. This effects are mainly mediated via cathecholaminergic action and cytokine production (1). β-blockers modulate both these pathways. There are several studies that have shown the benefits of β-blockers in sepsis. Animal studies have shown benefits of β-blockers (2,3,4,5). To date there is no published systematic review on the effect of β-blockers in sepsis. We sought to summarize
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Exclusion criteria were 1) paediatric patient’s 2) animal studies 3) non-septic patients. The eligible studies were heterogeneous and therefore did not permit statistical pooling.
Data Extraction
We (CJC & SG) independently reviewed the finalised articles to extract information on the following characteristic. Year of publication, sample size, study population, heart rate control, mortality rate, adverse incidence & change in metabolic parameters with administration of β-blockers. Individual authors were contacted to clarify overlapping of patients between studies. Authors were also contacted for data on subgroup analysis.
Study selection
Our electronic database search identified 1242 studies for initial abstract review. Abstract were reviewed by medical librarian (SP) and 2 authors (CJC and SG). We identified 31 texts for full text review. Of these 19 were excluded because they did not meet the inclusion/exclusion criteria, 10 editorial reviews, 2 non β-blockers (calcium channel blockers), 5 animal trials and 2 paediatric population (Fig 1). 3 studies which included 2 case series and 1 RCT were excluded after clarifying that they referred to the same cohort of patients (8,9,10). This was confirmed from personal correspondence with the author (8) and by identifying identical methodology and patient cohort in 2 studies (9,10). We requested
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