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While tachycardia is associated with adverse outcomes in septic shock, whether the elevated heart rate is pathologic or simply a marker for sympathetic stimulation is not clear. In a prospective observational study in an intensive care unit in Rome, investigators administered 24-hour esmolol drips titrated to a heart rate of 80 to 94 beats per minute (bpm) to 25 sedated and mechanically ventilated adult patients in septic shock after 24 hours of hemodynamic optimization. Eligible patients had heart rates greater than 95 bpm and initially required norepinephrine to maintain a mean arterial pressure of at least 65 mm Hg after fluid resuscitation. Patients with significant valvular disease, pronounced cardiac dysfunction, or ongoing need for i…