Safety and Efficacy of Ivabradine as A Rate Control For the Heart in Sepsis

Abstract

Sepsis and septic shock represent a major health problem among the critically ill patients all over the world, with associated substantial morbidity and mortality rates ranging from 18 % to 50 %. The incidence of sepsis has increased steadily over the last three decades, at least in part because of aging western population. Despite our increased understanding, improved support and more powerful antibiotic therapy, sepsis is still reported as the second leading cause of death in non-coronary intensive care units, and the tenth-mostcommon cause of death overall (the first being heart disease). Children under 12 months and elderly have the highest incidence of severe sepsis). The study was comparative prospective case / control study conducted on 60 critically ill patients admitted with sepsis and or septic shock to the Critical Care Department at Kobry Elkoba Military complex at 12 month from 8/2019 up to 8/ 2020. Patients who fulfilled the inclusion criteria. Eligible patients aged ≥18 years and presented with suspected Sepsis were evaluated in the ED and admitted to ICU where confirmed the primary diagnosis according to the following criteria (two of the following): temperature: >38Cº or < 36 Cº, heart rate > 90 BPM or SBP < 90 mmHg despite fluid resuscitation, respiratory rate > 20, Pco2< 32 mmHg, WBCs > 11 000 OR < 4 000/MM3 with immature bands >10% and suspected source of sepsis. Patients were divided into two groups:  Group (A): 30 patients received enteral Ivabrdaine in a dose of (5 mg every twelve hour daily) in addition to conventional treatment.  Group (B): 30 patients received conventional treatment only. Both groups were followed since admission and during their ICU stay and after 28 days from ICU discharge. APACHE II score was calculated on the admission day and SOFA score was calculated on days 0, 2 and 4. The mean age of the study group was 59.43 years, 71.7% (43 patients) were males and 28.3% (17 patients) were females. Chest infection was the predominant source of sepsis including (45%), other causes included 31.7% with UTI, 18.3% had infected bed sore. 18.3% medianitis. 16.7% had abdominal sepsis. 15% skin and soft tissue infection, 11.7% had bone or joint infection, 5% brain abscess. 5% infected prosthesis or device 3.3% infected endiocarditis.