Esmolol in septic shock: old pathophysiological concepts, an old drug, perhaps a new hemodynamic strategy in the right patient

During sepsis, sympathetic activation plays a pivotal role in optimizing cardiac output and blood pressure by acting on the interplays between heart rate (HR), contractility and vascular tone. The integrity of baroreflex function is fundamental for the maintenance of hemodynamic homeostasis. Accordingly, in the early phases of sepsis, tachycardia becomes a crucial mechanism for compensating the decrease in stroke volume (SV) and indicates the efficacy of baroreflex activity (1).