Esmolol may have some potential in treating septic shock and sepsis. However, the results remain controversial. We conduct a systematic review and meta-analysis to explore the efficacy of esmolol in patients with septic shock and sepsis.

PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched. Randomized controlled trials (RCTs) assessing the efficacy of esmolol for septic shock and sepsis are included. Two investigators independently search articles, extract data, and assess the quality of included studies. Meta-analysis is performed using the random-effect model.

Five RCTs are included in the meta-analysis. Overall, compared with control intervention in septic patients, esmolol intervention is found to significantly increase survival rate (risk ratio (RR)=2.06; 95% confidence interval (CI)=1.52 to 2.79; P=0.006), decrease heart rate (Standard Mean difference (Std. MD)=−2.43; 95% CI=−4.13 to −0.72; P=0.005) and TnI (Std. MD=−1.91; 95% CI=−2.39 to −1.43; P<0.00001), but has no significant impact on mean arterial pressure (MAP) (Std. MD=0.11; 95% CI=−0.21 to 0.44; P=0.49), central venous pressure (CVP) (Std. MD=−0.11; 95% CI=−0.50 to 0.28; P=0.58) and central venous oxygen saturation (ScvO2) (Std. MD=1.87; 95% CI=−1.53 to 5.26; P=0.28).

Esmolol treatment may be able to improve survival rate, and reduce heart rate and TnI, but has no influence on MAP, CVP and ScvO2 in patients with septic shock and sepsis.