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Effect of oral beta-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU Study.
Crit Care. 2010 Nov 3;14(6):R198
Authors: Noveanu M, Breidthardt T, Reichlin T, Gayat E, Potocki M, Pargger H, Heise A, Meissner J, Twerenbold R, Muravitskaya N, Mebazaa A, Mueller C
ABSTRACT: INTRODUCTION: Acute respiratory failure (ARF) is responsible for about one third of intensive care unit (ICU) admissions and associated with adverse outcome. Predictors of short and long-term outcome in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess effects of oral beta-blocker in unselected ICU patients with ARF included in the BASEL-II-ICU study. METHODS: The BASEL II-ICU study was a prospective, multicenter, randomized, single-blinded, controlled trial of 314 (mean age 70[62-79] years) ICU patients with ARF evaluating impact of a B-type natriuretic peptide (BNP) -guided management strategy on short-term outcome. RESULTS: In-hospital mortality was 16% (51 patients) and one-year mortality 41% (128 patients). Multivariate analysis assessed that oral beta-blockers at admission were associated with a lower risk of both in-hospital [HR 0.33 (0.14-0.74) p=0.007] and one-year mortality [HR 0.29 (0.16 to 0.51) p=0.0003]. Kaplan-Meier analysis confirmed the lower mortality in ARF patients when admitted with oral admission and further shows that the beneficial effect of oral beta-blockers at admission holds true in the 2 subgroups of patients with ARF related to cardiac or non-cardiac causes. Kaplan-Meier analysis also shows that administration of oral beta-blocker before hospital discharge gives striking additional beneficial effects on one-year mortality. CONCLUSIONS: Established beta-blocker therapy appears to be associated with a reduced mortality in ICU patients with acute respiratory failure. Cessation of established therapy appears to be hazardous. Initiation of therapy prior to discharge appears to confer benefit. This finding was seen regardless to the cardiac or non-cardiac etiology of respiratory failure. Trial registration clinicalTrials.gov Identifier: NCT00130559.
PMID: 21047406 [PubMed - as supplied by publisher]