In patients with septic shock, short-acting beta-blockers may improve survival and reduce new-onset tachyarrhythmias. However, these findings were based on low certainty evidence and given ongoing concerns regarding adverse effects and the increase duration of vasopressor use, we need larger and more rigorous RCTs to evaluate this intervention.

Twelve RCTs proved eligible (n = 1170 patients). Short-acting beta-blockers may reduce 28-day mortality (relative risk [RR], 0.76; 95% CI, 0.62–0.93; low certainty) and probably reduce new-onset tachyarrhythmias (RR, 0.37; 95% CI, 0.18–0.78; moderate certainty) but may increase the duration of vasopressors (mean difference [MD], 1.04 d; 95% CI, 0.37–1.72; low certainty).

Furthermore, there is an uncertain effect as to whether short-acting beta blockers impact 90-day mortality (RR, 0.98; 95% CI, 0.73–1.31), ICU length of stay (MD, –0.75 d; 95% CI, –3.43 to 1.93 d), hospital length of stay (MD, 1.03 d; 95% CI, –1.92 to 3.98 d), duration of mechanical ventilation (MD, –0.10 d; 95% CI, –1.25 to 1.05 d) (all very low certainty), bradycardia episodes (RR, 3.14; 95% CI, 0.91–14.01), and hypotension episodes (RR, 4.74; 95% CI, 1.62–14.01) (all very low certainty).

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