Study of hemodynamics in patients treated with landiolol in the ICU

Introduction

We experienced patients whose cardiac functions were maintained or deteriorated during the treatment of a short-acting β-blocker, landiolol. We therefore investigated the effects of landiolol on the cardiac function in patients.

Methods

From January through December 2007, 21 patients were selected if they had tachycardia (heart rate (HR) >100 beats/min) and they were treated with continuous infusion of landiolol. Hemodynamics were recorded using pulmonary artery catheters at four time points (before administration of landiolol, 1 hour after beginning of administration, immediately before discontinuation of administration, and 1 hour after discontinuation of administration). Infusion of landiolol was discontinued if the HR fell below 90 beats/min or the cardiac index (CI) fell below 2.0 l/min/m². The paired Student t test was used to compare the differences. P < 0.05 was statistically significant.

Results

Between the point before administration of landiolol (2.4 ± 1.8 (mean ± SD) μg/kg/min) and 1 hour after beginning of administration, although the HR was decreased from 137 ± 20 beats/min to 109 ± 20 beats/min (P < 0.01), the stroke index (SI) was increased from 20.4 ± 8.1 ml/beats/m² to 22.5 ± 7.0 ml/beats/m², and thus the CI was maintained (2.76 ± 1.05 l/min/m² and 2.43 ± 0.78 l/min/m²). Between the point before discontinuation of administration (1.4 ± 1.1 μg/kg/min) and 1 hour after discontinuation of administration, the HR was not increased significantly (93 ± 18 beats/min and 100 ± 16 beats/min), however the SI was increased 21.5 ± 6.7 ml/beats/m² to 25.7 ± 5.4 ml/beats/m² (P < 0.05), and therefore the CI was increased 1.93 ± 0.54 l/min/m² to 2.50 ± 0.40 l/min/m² (P < 0.01). Infusion of landiolol was discontinued because the HR fell below 90 beats/min in 12 patients and the CI fell below 2.0 l/min/m² in nine cases. There were no significant differences in the catecholamine index, pulmonary artery pressure, and central venous pressure.

Conclusion

We investigated hemodynamics in 21 patients who used landiolol and recognized the effects of rate control and depression of the SI and the CI; thus when we use landiolol, we have to pay attention to the HR and cardiac function [1].