The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit.
BACKGROUND
The safety of beta-blockers as a heart rate-limiting drug (HRLD) in patients with acute respiratory failure (ARF) due to chronic obstructive lung disease (COPD) has not been properly assessed in the intensive care unit (ICU) setting. This study aims to compare the use of beta-blocker drugs relative to non-beta-blocker ones in COPD patients with ARF due to heart rate-limiting with respect to length of ICU stay and mortality.


METHODS
We performed a retrospective (January 2011-December 2012) case-control study in a level III ICU in a teaching hospital. It was carried out in a closed ICU by the same intensivists. All COPD patients with ARF who were treated with beta-blockers (case group) and non-beta-blocker HRLDs (control group) were included. Their demographics, reason for HRLD, cause of ARF, comorbidities, ICU data including acute physiology and chronic health evaluation (APACHE II) score, type of ventilation, heart rate, and lengths of ICU and hospital stays were collected. The mortality rates in the ICU, the hospital, and over 30 days were also recorded.


RESULTS
We enrolled 188 patients (46 female, n = 74 and n = 114 for the case and control groups, respectively). Reasons for HRLD (case and control group, respectively) were atrial fibrillation (AF, 23% and 50%), and supraventricular tachycardia (SVT, 41.9% and 54.4%). Patients' characteristics, APACHE II score, heart rate, duration and type of ventilation, and median length of ICU-hospital stay were similar between the groups. The mortality outcomes in the ICU, hospital, and 30 days after discharge in the case and control groups were 17.6% versus 15.8% (p > 0.75); 18.9% versus 19.3% (p > 0.95) and 20% versus 11% (p > 0.47), respectively.


CONCLUSIONS
Our results suggest that beta-blocker use for heart rate control in COPD patients with ARF is associated with similar ICU stay length and mortality compared with COPD patients treated with other HRLDs.
Feyza
F
Kargin
Huriye Berk
HB
Takir
Cuneyt
C
Salturk
Nezihe Ciftaslan
NC
Goksenoglu
Can Yucel
CY
Karabay
Ozlem Yazicioglu
OY
Mocin
Nalan
N
Adiguzel
Gokay
G
Gungor
Merih Kalamanoglu
MK
Balci
Murat
M
Yalcinsoy
Ramazan
R
Kargin
Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, 34770 Umraniye, Istanbul, Turkey. zuhalkarakurt@hotmail.com.
Zuhal
Z
Karakurt