From Evidence to Bedside: The Role of Short-Acting β-Blockers in Sepsis Care

Sepsis remains a leading cause of critical illness and mortality worldwide, driven by a dysregulated host response to infection and often complicated by persistent tachycardia and cardiovascular dysfunction. Increasing evidence implicates excessive sympathetic activation as a contributor to sepsis-related hemodynamic instability and myocardial injury, prompting growing interest in the use of β-adrenergic blockade as a therapeutic adjunct. This review synthesizes current data on the safety and efficacy of short-acting, cardioselective β-blockers (BBs), particularly esmolol and landiolol, in septic shock. Emerging randomized trials and meta-analyses suggest that, when initiated after adequate resuscitation, BBs can reduce heart rate, improve stroke volume, and lower serum lactate levels without compromising mean arterial pressure or increasing vasopressor requirements in patients with septic shock. These physiologic improvements are associated with reduced 28-day mortality in select populations. However, the available evidence is limited by heterogeneity in trial design, small sample sizes, and variable patient selection, leaving unanswered questions regarding optimal timing, dosage, and patient stratification. While not yet the standard of care, β-blockade is a promising investigational strategy to mitigate sepsis-induced cardiovascular strain. Future multicenter trials are needed to validate its efficacy and establish clinical guidelines. Clinicians should remain cautiously optimistic when considering BBs for select patients with refractory tachycardia postresuscitation, ideally within structured protocols or ongoing research efforts.