Role of Ivabradine for Heart Rate Control in Management of Patients with Sepsis and Septic Shock

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are major healthcare problems, impacting millions of people around the world each year and killing between one in three and one in six of those it affects. Early identification and appropriate management in the initial hours after the develop-ment of sepsis improve outcomes. Aim of Study: To evaluate the role of heart rate control us-ing enteral Ivabradine (5 mg tab twice daily) in the management of patients with sepsis and /or septic shock as regards heart rate, vasopressors dose needed and mortality. Patients and Methods: This randomized controlled clinical trial was conducted on 76 patients with sepsis and septic shock who were selected from the Intensive Care Units. Randomiza-tion was performed according to computer-generated random number tables, and allocation to treatment group was done us-ing the sealed opaque envelope technique. According to ran-domization, patients who met the inclusion criteria were ran-domly divided into two groups: Group (A): Patients received Ivabradine (5mg tab twice daily) [Napibradine: Global NAPI pharmaceutical] orally or via nasogastric tube.Group (B): Pa-tients didn’t receive Ivabradine. Results: This study compared two groups of patients with sepsis, focusing on baseline characteristics, clinical presenta-tions, and outcomes. There were no significant differences be-tween the groups in baseline demographics, comorbidities, or initial clinical parameters. However, after 72 hours, group A demonstrated significantly better outcomes, with lower heart rate, base excess, lactate, SOFA score, and APACHE-II, and higher temperature, oxygen saturation, ejection fraction, and stroke volume index (all p<0.05). Group A also required low-er noradrenaline doses and had a lower vasoactive–inotropic score at 72 hours. Mortality was significantly lower in group A (26.32%) compared to group B (52.63%, p=0.019). There were no significant differences in ICU stay, mechanical ventilation (MV), renal replacement therapy (RRT), hepatic dysfunction, or new-onset seizures. Ivabradine use, along with hyperten-sion, fluid intake, lactate, SOFA, and APACHE-II scores, were identified as significant mortality predictors. Ivabradine was well-tolerated without severe bradycardia or conduction issues. Conclusion: The administration of enteral ivabradine to patients with septic shock resulted in a significant reduction in heart rate and vasopressor requirements and mortality.