Beta-Adrenergic Antagonists: Indications and Potential Immunomodulatory Side Effects in the Critically Ill

Pharmacologic blockade of adrenergic receptors is a frequent therapeutic intervention in critically ill patients. Today's strategies predominantly include the treatment of cardiovascular diseases like hypertension and cardiac arrhythmias. Furthermore, adrenergic antagonists are routinely used to prevent the catecholamine-induced hypermetabolism in critically ill patients suffering from severe burn injury. In addition to these well known beneficial effects of beta-adrenoceptor blocking agents it has been demonstrated, that the adrenergic system is involved in the modulation of cellular immune functions. Therefore, the immunomodulatory properties of beta-adrenergic antagonists have been established during the last years and the scientific focus was addressed on the proposed immunologic side effects of a beta-adrenergic blockade and its potential effect on the clinical course of critical illness. This manuscript reviews the rational and the effect of the therapeutic use of beta-adrenergic antagonists in critically ill patients on the base of the current literature and further emphasizes on potential immunologic side effects.