Effect of Dexmedetomidine vs Esmolol or Placebo on Cerebral Hemodynamics in Septic Shock
Status:
Completed
Trial end date:
2023-11-01
Target enrollment:
Participant gender:
Summary
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host
response to infection. Some researchers proposed that the dysregulated response or organ
dysfunction can be lessened by reducing the stress response, which further reduce
complication and mortality rates of sepsis. Dexmedetomidine is alpha adrenergic receptor
agonist, presenting sympatholytic action in certain parts of the brain with anxiolytic,
sedative, and pain killing effects. In the experiments of sepsis animal model,
dexmedetomidine have been proved to improve serum lactate clearance and the microcirculation.
Dexmedetomidine may inhibit inflammation, as it enhances the activity of the immune system
while reducing its systemic reaction and lowering cytokine concentrations. There are also
evidences in clinical trials with definite safety that dexmedetomidine reduced inflammation,
reduced vasopressor requirements and improved organ function. The beta antagonist esmolol has
been proposed as a therapy to lower heart rate, thereby improving diastolic filling time, and
improving cardiac output, resulting in a reduction in vasopressor support. A recent
meta-analysis of 8 randomized studies using esmolol suggested that the 32% risk ratio
decreased 28-day mortality, and a meta-analysis of 7 studies using esmolol in patients with
sepsis and septic shock was associated with 32% lower 28-day mortality. However, the effect
of anti-stress drugs on cerebral hemodynamics is unknown. In this study, investigators are
going to apply the technique of transcranial Doppler to assess the reaction of cerebral blood
flow in anti-stress group and control group.