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Tachycardia during septic shock could reflect hyperadrenergic responses or catecholamine-induced cardiac toxic effects and could increase cardiac workload and myocardial oxygen consumption while reducing cardiac perfusion from a shortened diastolic phase. In an open-label, randomized trial, investigators compared intravenous esmolol or standard treatment in 154 patients in septic shock who had heart rates >95 beats per minute and required norepinephrine to maintain mean arterial blood pressure >65 mm Hg. β-blocker therapy was titrated to achieve heart rates between 80 and 94 beats per minute and continued until intensive care unit discharge or death. All patients received other standard aggressive resuscitation and management protocols.
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