STRESS-L
Trial question
What is the role of landiolol infusion in patients with tachycardia and established septic shock treated for at least 24 hours with continuous norepinephrine.
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 126
126 patients (52 female, 74 male).
Inclusion criteria: adult patients with tachycardia and established septic shock treated for at least 24 hours with continuous norepinephrine.
Key exclusion criteria: tachycardia because of pain or discomfort; any noninfective form of vasodilatory shock.
Interventions
N=63 landiolol infusion (continuous infusion during ICU stay starting at 1.0 mcg/kg/min and titrated to reach target HR).
N=63 standard care (no receipt of landiolol during ICU stay).
Primary outcome
Mean Sequential Organ Failure Assessment score at day 14
8.8 points
8.1 points
8.8 points
6.6 points
4.4 points
2.2 points
0.0 points
Landiolol
infusion
Standard
care
No significant
difference ↔
No significant difference in mean SOFA score at day 14 (8.8 points vs. 8.1 points; MD 0.75, 95% CI -0.49 to 2).
Secondary outcomes
No significant difference in death at day 28 (37.1% vs. 25.4%; AD 11.7%, 95% CI -4.4 to 27.8).
No significant difference in death at day 90 (43.5% vs. 28.6%; AD 15%, 95% CI -1.7 to 31.6).
No significant difference in length of stay in the ICU survivors (21.3 days vs. 19.6 days; MD 1.72, 95% CI -8.94 to 12.39).
Safety outcomes
No significant difference in adverse events.
Significant difference in serious adverse events (25.4% vs. 6.4%).
Conclusion
In adult patients with tachycardia and established septic shock treated for at least 24 hours with continuous norepinephrine, landiolol infusion was not superior to standard care with respect to mean SOFA score at day 14.
Reference
Tony Whitehouse, Anower Hossain, Gavin D Perkins et al. Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial. JAMA. 2023 Nov 7;330(17):1641-1652.
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