A heart rate higher than 90?beats/min indicates an unfavorable prognosis for patients with sepsis and MODS . We thought to investigate the effect of the pacemaker current (If) inhibitor Ivabradine on heart rate, hemodynamics, and disease severity among patients with sepsis and multi organ dysfunction syndrome
To evalute the role of ivabradine in managememt of patients with MODS and its effect on outcome
In this prospective, controlled, randomized trial, We evaluated 50 patients with sepsis and or multi organ dysfunction syndrome and sinus rhythm of at least 90?beats/min , informed consent was taken from all patients included in the study then patients were divided into two groups, Group A ;25 patients receiveng the conventional treatment plus Ivabradine (5?mg twice daily) via the enteral route and Group B 25 patients receiveng only conventional treatment.follow up patients for 30 days was done ,Echocardiography was done to evaluate diastlic dysfunction at day 0 and day 4.
Our results showed no significant differnce between both groups regarding age ,gender, demographics and admission hemodynamics and heart rate. After 96 h from ICU admission there was a significant difference between both groups in the heart rate reduction ; 24 beats/min(from 118 to 94 beats/min) in the group B and 33 beats/min(from 117 to 84 beats/min) in the Ivabradine group Group A ( p ?= ?0.023).
Ivabradine had an impact on decreasing diastolic functionon MODS Patients.There was significant improvement in diastolic function at least one grade from base line in the group reciveng Ivabradine (p = 0.038).
There was no difference between the two groups regarding length of hospital stay ,in-hospital mortality or 30 days mortality .
Use of enteral Ivabradine can reduce elevated heart rate and improve diastolic function in patients with MODS and sepsis but it has no impact on overall survival, length of ICU stay, or days on mechanical ventilation, vasopressors .