Your browser doesn't support javascript.
Metoprolol in Critically Ill Patients With COVID-19.
Clemente-Moragón, Agustín; Martínez-Milla, Juan; Oliver, Eduardo; Santos, Arnoldo; Flandes, Javier; Fernández, Iker; Rodríguez-González, Lorena; Serrano Del Castillo, Cristina; Ioan, Ana-María; López-Álvarez, María; Gómez-Talavera, Sandra; Galán-Arriola, Carlos; Fuster, Valentín; Pérez-Calvo, César; Ibáñez, Borja.
  • Clemente-Moragón A; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
  • Martínez-Milla J; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
  • Oliver E; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
  • Santos A; Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
  • Flandes J; Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
  • Fernández I; Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
  • Rodríguez-González L; Pathology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; Biobank Patform-PT20/00141, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain.
  • Serrano Del Castillo C; Flow Citometry Laboratory, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
  • Ioan AM; Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
  • López-Álvarez M; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
  • Gómez-Talavera S; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
  • Galán-Arriola C; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
  • Fuster V; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • Pérez-Calvo C; Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
  • Ibáñez B; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain. Electronic address: bibanez@cnic.es.
J Am Coll Cardiol ; 78(10): 1001-1011, 2021 09 07.
Article in English | MEDLINE | ID: covidwho-1371478
ABSTRACT

BACKGROUND:

Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting.

OBJECTIVES:

The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS.

METHODS:

A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after metoprolol/control. The safety of metoprolol administration was evaluated by invasive hemodynamic and electrocardiogram monitoring and echocardiography.

RESULTS:

Metoprolol administration was without side effects. At baseline, neutrophil content in BAL did not differ between groups. Conversely, patients randomized to metoprolol had significantly fewer neutrophils in BAL on day 4 (median 14.3 neutrophils/µl [Q1, Q3 4.63, 265 neutrophils/µl] vs median 397 neutrophils/µl [Q1, Q3 222, 1,346 neutrophils/µl] in the metoprolol and control groups, respectively; P = 0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2FiO2) significantly improved after 3 days of metoprolol treatment (median 130 [Q1, Q3 110, 162] vs median 267 [Q1, Q3 199, 298] at baseline and day 4, respectively; P = 0.003), whereas it remained unchanged in control subjects. Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5 ± 7.6 vs 21.9 ± 12.6 days; P = 0.17).

CONCLUSIONS:

In this pilot trial, intravenous metoprolol administration to patients with COVID-19-associated ARDS was safe, reduced exacerbated lung inflammation, and improved oxygenation. Repurposing metoprolol for COVID-19-associated ARDS appears to be a safe and inexpensive strategy that can alleviate the burden of the COVID-19 pandemic.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Critical Illness / Pandemics / SARS-CoV-2 / COVID-19 / Metoprolol Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Am Coll Cardiol Year: 2021 Document Type: Article Affiliation country: J.jacc.2021.07.003

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Critical Illness / Pandemics / SARS-CoV-2 / COVID-19 / Metoprolol Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Am Coll Cardiol Year: 2021 Document Type: Article Affiliation country: J.jacc.2021.07.003