RCT

STRESS-L

Landiolol and Organ Failure in Patients With Septic Shock

JAMA, 2023 · Multicenter randomized clinical trial

Clinical question

Does landiolol-guided heart-rate reduction improve organ failure in persistent tachycardic septic shock?

Population: Adults with tachycardia and established septic shock requiring norepinephrine >24 h
Intervention: Landiolol infusion
Comparator: Standard care
Primary outcome: Mean SOFA score through 14 days
Result: No significant reduction in organ failure; trial stopped early with a possible harm signal.

What the trial found

Routine landiolol for persistent tachycardia in established septic shock was not supported.

Current guideline position

Not recommended as routine septic-shock therapy.

Clinical interpretation

Do not use beta-blockade routinely simply to normalize heart rate in vasopressor-dependent septic shock.

Clinical Context & Relevant Topics (2)

Disease Reference

Septic Shock

The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.

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Sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.

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