Clinical efficacy of esmolol initiation timing in sepsis patients with tachyarrhythmia

Objective To investigate the effects of initiating esmolol after fluid resuscitation on physiological parameters and clinical outcomes in patients with sepsis-associated tachyarrhythmia. Methods A total of 76 septic patients with tachyarrhythmia who received esmolol treatment in the Intensive Care Unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from January 2023 to June 2025 were selected and their clinical data were collected for retrospective analysis. According to whether fluid resuscitation had been achieved at the time of esmolol initiation [defined as mean arterial pressure (MAP) ≥65 mmHg, lactate reduction ≥10% from peak value, and urine output ≥0.5 mL·kg-1·h-1 sustained for ≥2 h], patients were divided into two groups: a completed resuscitation group (n=39) and an incompleted resuscitation group (n=37). Their eart rate, MAP, blood lactate, oxygenation index, cardiac biomarkers (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T), and norepinephrine equivalent doses were compared before and after treatment at different time points. The length of ICU stay, total length of hospitalization stay, and 28-day mortality were also analyzed. A subgroup analysis based on left atrial volume index was performed to assess cardiac function. Results After treatment, heart rate in both groups decreased significantly and reached target levels (HR ≤ 100 beats/min, MAP ≥ 65 mmHg), with no intergroup difference. Compared with the incompleted resuscitation group, the completed resuscitation group showed lower lactate levels and better improvement in oxygenation index, but lower MAP (all P<0.05). Norepinephrine equivalent doses in the completed resuscitation group were lower than those in the incompleted resuscitation group from 12 h onward (P<0.05), and the median dose decreased to 0.00 after 24 h, accompanied by a shorter length of ICU stay (P<0.05). No statistically significant differences were observed in cardiac biomarkers or 28-day mortality between the two groups. In the subgroup with cardiac dysfunction, the completed resuscitation group had significantly lower lactate and N-terminal pro-B-type natriuretic peptide levels (P<0.05). Conclusions Initiating esmolol after completion of fluid resuscitation in septic patients with tachyarrhythmia improves short-term physiological outcomes, including lactate clearance, oxygenation, and vasopressor reduction, and shortens length of ICU stay. However, its impact on long-term prognosis, particularly 28-day mortality, requires further investigation.