The Outcome of Using Ivabradine in Septic Shock Patients in Improving Cardiac Output Assessed by Transthoracic Echocardiography

Background: Septic shock is distinguished by vasodilation, hypotension, and hyperdynamic circulation, leading to reflex tachycardia as a compensatory response. The sympathetic nervous system (SNS) and inflammatory mediators (e.g., catecholamines, cytokines) drive increased heart rate (HR) to preserve cardiac output (CO) in response to low systemic vascular resistance (SVR). Persistent tachycardia (>100–120 bpm) is common and may be harmful if prolonged. A lot of consequences include increased myocardial oxygen demand, reduced stroke volume, and worsening organ perfusion Objectives: This research aimed to study primarily the effect of ivabradine on cardiac output in septic shock cases by transthoracic echocardiography. Methods: Sixty cases with septic shock were enrolled in a prospective, randomized, controlled clinical research in the intensive care departments of Menoufia University Hospital and Shebin el-Koum Teaching Hospital. Cases had been separated into two groups: Case group, where septic shock cases treated with ivabradine (dose of 5 mg/12 hrs.) orally or crushed and then infused through a nasogastric tube beside regular management and control group (Septic shock patients treated with regular management without using ivabradine). Results: A significant variance had been observed in cardiac output, heart rate, stroke volume index (SVI), mean arterial blood pressure (MAP), and left ventricular ejection fraction (LVEF%) (P-value < 0.05). The ivabradine group illustrated more improvement in cardiac output, more reduction in HR, and improvement in SVI, velocity time integral (VTI), MAP, and LVEF%. The ivabradine group showed more improvement in sequential organ failure assessment (SOFA) score and lactate level. The ivabradine group showed more reduction in intensive care unit length of stay and death. The ivabradine group showed more recovery (80%). Conclusion: Ivabradine in septic shock patients had significantly better effects with regard to cardiac output, heart rate control, and the ICU outcome.