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In intensive care conditions, the initial adrenergic stimulation may be beneficial. However, persistent sympathetic overactivity may become deleterious, leading not only to haemodynamic alterations, but also to cardiotoxicity, metabolic derangement, immunosuppression, and hypercoagulability. Using beta-blockers have been shown to improve various cardiovascular diseases. However, long-acting beta-blockers can have negative effects that are difficult to be reversed in rapidly changing conditions. Currently, esmolol and landiolol are the only 2 ultra-short acting beta-blockers available in clinical practice of intensive care patients. Esmolol was the first available ultra-short acting beta-blocker with a half-life of 9 minutes, while landiolol is beta-blocker with a half-life of 3-4 minutes. Recent clinical studies reported that using ultra-short acting selective beta-blockers treat and prevent supraventricular arrythmia. It has been shown that these drugs can control septic tachycardia due to sympathetic overstimulation and decreasing oxygen consumption in acute myocardial infarction. Further, their use was applied in management of aortic dissection before surgery and systolic anterior motion of mitral valve. Moreover, the recent studies demonstrated that ultra-short acting beta-blockers may have a potential role in improvement of arterial oxygenation in ECMO patients. New data using of ultra-short acting beta-blockers are promising, but in the future more RCTs are needed to show the clinical evidence.
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