The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit

Feyza Kargin; Huriye Berk Takir; Cuneyt Salturk; Nezihe Ciftaslan Goksenoglu; Can Yucel Karabay; Ozlem Yazicioglu Mocin; Nalal Adiguzel; Gokay Gungor; Merih Kalamanoglu Balci; Murat Yalcinsoy; Ramazan Kargin; Zuhal Karakurt

doi:10.4081/mrm.2014.365

The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit

Authors

Feyza Kargin Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Huriye Berk Takir Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Cuneyt Salturk Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Nezihe Ciftaslan Goksenoglu Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Can Yucel Karabay Department of Cardiology, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul
Ozlem Yazicioglu Mocin Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Nalal Adiguzel Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Gokay Gungor Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Merih Kalamanoglu Balci Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Murat Yalcinsoy Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul
Ramazan Kargin Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul
Zuhal Karakurt Respiratory and Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Soyak Yenişehir Manolya Evleri, Istanbul

DOI: https://doi.org/10.4081/mrm.2014.365

Keywords:

Acute respiratory failure, Arrhythmia, Beta-blockers, COPD

Abstract

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.