Predicting Early Circulatory Deterioration After Short-Acting Beta-Blocker Treatment in Intensive Care Patients

This retrospective observational study used existing intensive care records to examine whether heart rate and blood pressure measured before short-acting beta-blocker treatment could help predict early signs of worsening circulation recorded after treatment. The study included patients who had received intravenous esmolol or landiolol during routine care. Researchers did not assign treatment or change patient care. The main analysis used records from Zhongshan Hospital, Fudan University. Additional intensive care databases were used to evaluate whether a prediction model developed at this hospital could be applied to other patient populations. The main questions were whether pretreatment heart rate and blood pressure could predict recorded circulatory changes, whether combining these measurements improved prediction over simpler blood pressure measures, and whether differences in blood pressure monitoring affected the findings. The main outcome combined a recorded fall in blood pressure, initiation or escalation of norepinephrine (a medicine used to support blood pressure), or early discontinuation of the same beta-blocker. Blood pressure and norepinephrine changes were assessed during the first three hours after the treatment index, and drug discontinuation during the first hour. External database analyses focused on recorded low blood pressure during the first three hours. The study evaluated prediction among patients who had already received treatment. It was not designed to determine whether beta-blockers caused these events or whether a patient should receive a beta-blocker. Data collection and the analyses described here were completed before registration.