Heart rate reduction may be a major determinant of vascular tone in esmolol-treated septic shock patients—although still remains to be confirmed!

Over the last decade, the regulation of the autonomic nervous system by β1-adrenoreceptor antagonists in septic shock patients has been the subject of growing literature. In 2013, Morelli et al. published a randomized, controlled, open-label, single-center phase 2 trial investigating the efficacy of intravenous esmolol, a short acting β1-blocker titrated to lower heart rate (HR) in septic shock patients with severe tachycardia. This study found that esmolol was associated with a reduction in HR to the specified target range (80–94 bpm), maintained cardiac output, increased systemic vascular resistances along with a subsequent reduction in norepinephrine dose requirements (1).