Beta-blocker therapy in pediatric intensive care: Safety and efficacy of propranolol for persistent tachycardia.

ObjectiveTachycardia is common in pediatric intensive care and may contribute to hemodynamic instability when persistent despite adequate resuscitation. Data on β-blocker therapy in critically ill children are limited. Our objective was to evaluate the safety and hemodynamic effects of propranolol in critically ill pediatric patients with persistent sinus tachycardia.MethodsRetrospective cohort study of children aged 1 month to 18 years who received propranolol in a tertiary-care pediatric intensive care unit between March 1, 2019, and March 1, 2024. The inclusion criteria were heart rate ≥2 standard deviations above age norms that persisted despite adequate resuscitation and conventional treatments. Patients with primary cardiac disease or a history of β-blocker use were excluded. Propranolol was administered orally or via a nasogastric tube at a dose of 1 mg/kg/day for persistent sinus tachycardia despite normothermia, adequate sedation-analgesia, and standard hemodynamic support. The primary outcome was the change in heart rate over 48 h. Secondary outcomes included trends in blood pressure, lactate and glucose levels, vasoactive-inotropic score (VIS), and adverse events.ResultsAmong 93 patients (median age, 19 months), propranolol caused a significant reduction in heart rate within 6 h (mean decrease, ∼30 bpm; p < 0.001), with stabilization by 24 h. Systolic (SBP) and diastolic blood pressures (DBP) increased modestly (SBP +7 mmHg; DBP +3 mmHg, p < 0.001), and lactate levels declined significantly at 6 h (p = 0.003). The VIS did not change significantly. Adverse events were rare (hypotension 2.2%, bradycardia 1.1%).ConclusionsIn this large pediatric cohort, propranolol was well tolerated and linked to positive hemodynamic and metabolic effects. These results support cautious use in carefully selected critically ill children and emphasize the need for future prospective trials.