It's fairly well accepted that chronic beta blockade should not be withheld at times of stress. The POISE trial considered whether starting beta blockers before major non cardiac surgery improved outcome (it didn't - the results showed less MI but more CVAs and increased mortality). This paper goes towards considering the same for sepsis.
There's lots we can discuss, but you might want to consider:
- Does the title reflect the primary outcome?
- How do you think using levosimendin rather than dobutamine might have affected the results?
- There was no difference in levosimendin use between the groups. Would you expect there to be?
- The hypothesis was that beta blockade increased cardiac output. Are there any other possible explanations for the reduction in noradrenaline requirement (rise in BP)?
- What effects of beta blockers other than bradycardia may account for the improved 28 day mortality?
- Are you convinced? Would you start an Esmolol infusion on your next patient with severe sepsis?