Metoprolol in Critically Ill Patients With COVID-19

Autor: Lorena Rodríguez-González, Cristina Serrano del Castillo, Javier Flandes, Iker Fernández, María López-Álvarez, Juan Martínez-Milla, Ana-Maria Ioan, Valentin Fuster, Borja Ibanez, Carlos Galán-Arriola, Sandra Gómez-Talavera, Arnoldo Santos, César Pérez-Calvo, Agustín Clemente-Moragón, Eduardo Oliver
Přispěvatelé: Ministerio de Ciencia e Innovación (España), Instituto de Salud Carlos III, Fundación ProCNIC, Unión Europea. Comisión Europea. European Research Council (ERC), Comunidad de Madrid (España)
Rok vydání: 2021
Předmět:
Adult
Male
ARDS
Critical Illness
medicine.medical_treatment
Original Investigations
Pilot Projects
NET
neutrophil extracellular trap
medicine
Humans
Respiratory function
Prospective Studies
cardiovascular diseases
Myocardial infarction
Pandemics
ARDS
acute respiratory distress syndrome
Aged
COVID
Metoprolol
Mechanical ventilation
Lung
COVID-19
coronavirus disease-2019
medicine.diagnostic_test
SARS-CoV-2
business.industry
COVID-19
Neutrophil extracellular traps
Middle Aged
medicine.disease
Adrenergic beta-1 Receptor Antagonists
Respiration
Artificial
metoprolol
ICU
intensive care unit
IMV
invasive mechanical ventilation
Bronchoalveolar lavage
medicine.anatomical_structure
Anesthesia
Injections
Intravenous
Female
BAL
bronchoalveolar lavage
acute care
Cardiology and Cardiovascular Medicine
business
circulatory and respiratory physiology
medicine.drug
Zdroj: Journal of the American College of Cardiology
ISSN: 0735-1097
DOI: 10.1016/j.jacc.2021.07.003
Popis: Background Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting. Objectives The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19–associated ARDS. Methods A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after metoprolol/control. The safety of metoprolol administration was evaluated by invasive hemodynamic and electrocardiogram monitoring and echocardiography. Results Metoprolol administration was without side effects. At baseline, neutrophil content in BAL did not differ between groups. Conversely, patients randomized to metoprolol had significantly fewer neutrophils in BAL on day 4 (median: 14.3 neutrophils/µl [Q1, Q3: 4.63, 265 neutrophils/µl] vs median: 397 neutrophils/µl [Q1, Q3: 222, 1,346 neutrophils/µl] in the metoprolol and control groups, respectively; P = 0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment (median: 130 [Q1, Q3: 110, 162] vs median: 267 [Q1, Q3: 199, 298] at baseline and day 4, respectively; P = 0.003), whereas it remained unchanged in control subjects. Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5 ± 7.6 vs 21.9 ± 12.6 days; P = 0.17). Conclusions In this pilot trial, intravenous metoprolol administration to patients with COVID-19–associated ARDS was safe, reduced exacerbated lung inflammation, and improved oxygenation. Repurposing metoprolol for COVID-19–associated ARDS appears to be a safe and inexpensive strategy that can alleviate the burden of the COVID-19 pandemic.
Central Illustration
Databáze: OpenAIRE
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