At present, there are few studies on Esmolol in acute respiratory distress syndrome. However,
previous studies have shown that Esmolol can improve oxygenation and reduce the levels of
inflammatory cytokines and exudate proteins in bronchoalveolar lavage fluid, thus alleviating
pulmonary injury. Considering that a considerable number of ARDS patients in the intensive
care unit suffer from sepsis, we conducted this study to explore the application timing of
esmolol therapy and whether esmolol can improve the symptoms and prognosis of ARDS patients.
Based on the literature and our previous clinical observations, we make the following
assumptions: Esmolol is applied to various ARDS patients receiving mechanical ventilation in
ICU. By inhibiting the β-adrenergic receptor to control the heart rate, it can ultimately
improve the oxygenation index of patients, shorten the mechanical ventilation time, achieve
tracheal intubation extraction as soon as possible, and reduce the 28-day mortality. At the
same time, esmolol can also improve the function of various organs of patients and reduce the
level of inflammatory factors. This project intends to include ARDS patients with optimal
hemodynamic treatment for 24 hours, whose heart rate is still ≥95 beats/min after
conventional treatment, but ≤120 beats/min. They are randomly divided into control group and
Esmolol treatment group to study the effects of esmolol on patients' oxygenation index,
mechanical ventilation time, hemodynamics, function of various organs and inflammation level.
To optimize the treatment of ARDS patients.
Acute respiratory distress syndrome (ARDS) is a clinical syndrome caused by intrapulmonary
and/or extrapulmonary causes, characterized by intractable hypoxemia. ARDS is the most common
cause of respiratory failure in severe patients, and also the main factor leading to poor
prognosis in severe patients. In recent years, although the research on ARDS has continued to
go deeper, clinical treatment still remains in the stage of lung protective ventilation and
restricted fluid management, and there is still a lack of specific drug therapy, and the
fatality rate is still as high as 40%.
Studies have shown that the sympathetic nervous system is over-activated in patients with
acute respiratory distress syndrome. Because 75 to 80 percent of myocardial adrenergic
receptors are β1 type, and adrenergic stress is primarily mediated by beta receptors, the
heart is a prime target for sympathetic overstimulation. Elevated heart rate is associated
with adverse outcomes in patients with severe infection and represents the severity of the
disease.Another large retrospective study showed a reduction in mortality in ARDS patients
treated with oral β1 blockers before admission, and this beneficial effect of β1 blockers
applies to ARDS patients with or without cardiac disease.
Esmolol is an ultra-short-acting selective β1 receptor blocker, which mainly inhibits β1
receptor by competing for catecholamine binding sites in myocaroma, and has the effect of
slowing resting and exercise heart rate, lowering blood pressure, and reducing myocardial
oxygen consumption. Esmolol is a metabolite coupled with enzyme, so its distribution
half-life is very short, intravenous injection begins to take effect 1-2 min, elimination
half-life is only 9min, easy to control, high safety, and remarkable effect. There have been
numerous studies on esmolol in sepsis. For patients with septic shock, the use of esmolol can
reduce heart rate to the target level, but does not increase the incidence of adverse events,
and does not reduce microcirculation perfusion, and can improve the hemodynamics and 28-day
mortality of patients. In addition, both animal and human experiments have proved that
Esmolol can reduce the release of inflammatory factors in sepsis, improve inflammatory
response, and protect cardiac and renal function.
At present, there are few studies on Esmolol in acute respiratory distress syndrome. However,
previous studies have shown that Esmolol can improve oxygenation and reduce the levels of
inflammatory cytokines and exudate proteins in bronchoalveolar lavage fluid, thus alleviating
pulmonary injury. Considering that a considerable number of ARDS patients in the intensive
care unit suffer from sepsis, we conducted this study to explore the application timing of
esmolol therapy and whether esmolol can improve the symptoms and prognosis of ARDS patients.
Based on the literature and our previous clinical observations, we make the following
assumptions: Esmolol is applied to various ARDS patients receiving mechanical ventilation in
ICU. By inhibiting the β-adrenergic receptor to control the heart rate, it can ultimately
improve the oxygenation index of patients, shorten the mechanical ventilation time, achieve
tracheal intubation extraction as soon as possible, and reduce the 28-day mortality. At the
same time, esmolol can also improve the function of various organs of patients and reduce the
level of inflammatory factors. This project intends to include ARDS patients with optimal
hemodynamic treatment for 24 hours, whose heart rate is still ≥95 beats/min after
conventional treatment, but ≤120 beats/min. They are randomly divided into control group and
Esmolol treatment group to study the effects of esmolol on patients' oxygenation index,
mechanical ventilation time, hemodynamics, function of various organs and inflammation level.
To optimize the treatment of ARDS patients.
To evaluate the effect of Esmolol control on heart rate in patients with acute respiratory
distress syndrome (ARDS) on oxygenation index. A total of 187 patients aged 18-65 years who
met the 2012 Berlin diagnostic criteria for acute respiratory distress syndrome will be
included in our study. Hemodynamic optimization was performed within 24 hours after
diagnosis. After treatment, the patient's heart rate continued to be ≥95 beats/min but ≤120
beats/min for at least 10 minutes, with or without esmolol pumping. The improvement of
oxygenation index in different treatment groups was observed.
