RT Journal Article
SR Electronic
T1 Study into the reversal of septic shock with landiolol (beta blockade): STRESS-L Study protocol for a randomised trial
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e043194
DO 10.1136/bmjopen-2020-043194
VO 11
IS 2
A1 Ranjit Lall
A1 Dipesh Mistry
A1 Emma Skilton
A1 Nafisa Boota
A1 Scott Regan
A1 Julian Bion
A1 Simon Gates
A1 Anthony C Gordon
A1 Janet Lord
A1 Daniel Francis McAuley
A1 Gavin Perkins
A1 Mervyn Singer
A1 Duncan Young
A1 Tony Whitehouse
YR 2021
UL http://bmjopen.bmj.com/content/11/2/e043194.abstract
AB Introduction In 2013, a single-centre study reported the safe use of esmolol in patients with septic shock and tachycardia who required vasopressor therapy for more than 24 hours. Although not powered to detect a change in mortality, marked improvements were seen in survival (adjusted HR, 0.39; 95% CI, 0.26 to 0.59; p<0.001). Beta blockers are one of the most studied groups of drugs but their effect in septic shock is poorly understood; proposed mechanisms include not only the modulation of cardiac function but also immunomodulation.Methods and analysis STRESS-L is a randomised, open-label, non-blinded clinical trial which is enrolling a total of 340 patients with septic shock as defined by Sepsis-3 consensus definition and a tachycardia (heart rate ≥95 beats per minute (bpm)) after vasopressor treatment of at least 24 hours. Standard randomisation (1:1 ratio) allocates patients to receive usual care (according to international standards) versus usual care and a continuous landiolol infusion to reduce the heart rate between 80 and 94 bpm. The primary endpoint is the mean Sequential Organ Failure Assessment score over 14 days from entry into the trial and while in intensive care unit. Results will inform current clinical practice guidelines.Ethics and dissemination This trial has clinical trial authorisation from the UK competent authority, the Medicines and Healthcare products Regulatory Agency, and has been approved by the East of England-Essex Research Ethics Committee (reference: 17/EE/0368).The results of the trial will be reported first to trial collaborators. The main report will be drafted by the trial coordinating team, and the final version will be agreed by the Trial Steering Committee before submission for publication, on behalf of the collaboration.Registration The trial is funded by the National Institute for Health Research Efficacy and Mechanism Evaluation (EME) (Project Number: EME-14/150/85) and registered ISRCTN12600919 and EudraCT: 2017-001785-14.