Beta-adrenergic antagonists: indications and potential immunomodulatory side effects in the critically ill.
Pharmacologic blockade of beta-adrenergic receptors is a frequent therapeutic intervention in critically ill patients. Today's strategies predominantly include the treatment of cardiovascular diseases like hypertension and cardiac arrhythmias. Furthermore, beta-adrenergic antagonists are routinely used to prevent the catecholamine-induced hypermetabolism in critically ill patients suffering from severe burn injury. In addition to these well known beneficial effects of beta-adrenoceptor blocking agents it has been demonstrated, that the adrenergic system is involved in the modulation of cellular immune functions. Therefore, the immunomodulatory properties of beta-adrenergic antagonists have been established during the last years and the scientific focus was addressed on the proposed immunologic side effects of a beta-adrenergic blockade and its potential effect on the clinical course of critical illness. This manuscript reviews the rational and the effect of the therapeutic use of beta-adrenergic antagonists in critically ill patients on the base of the current literature and further emphasizes on potential immunologic side effects.
Oberbeck
Reiner
R
Department Trauma Surgery, University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany. reineroberbeck@hotmail.com
Kobbe
Philipp
P
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D002395:Catecholamines / Q000627:therapeutic use; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D002395:Catecholamines; D007155:Immunologic Factors