{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:58:17Z","timestamp":1792119497153,"version":"4.4.0"},"reference-count":164,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T00:00:00Z","timestamp":1721779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>The autonomic nervous system plays a key role in maintaining body hemostasis through both the sympathetic and parasympathetic nervous systems. Sympathetic overstimulation as a reflex to multiple pathologies, such as septic shock, brain injury, cardiogenic shock, and cardiac arrest, could be harmful and lead to autonomic and immunologic dysfunction. The continuous stimulation of the beta receptors on immune cells has an inhibitory effect on these cells and may lead to immunologic dysfunction through enhancing the production of anti-inflammatory cytokines, such as interleukin-10 (IL-10), and inhibiting the production of pro-inflammatory factors, such as interleukin-1B IL-1B and tissue necrotizing factor-alpha (TNF-alpha). Sympathetic overstimulation-induced autonomic dysfunction may also happen due to adrenergic receptor insensitivity or downregulation. Administering anti-adrenergic medication, such as beta-blockers, is a promising treatment to compensate against the undesired effects of adrenergic surge. Despite many misconceptions about beta-blockers, beta-blockers have shown a promising effect in decreasing mortality in patients with critical illness. In this review, we summarize the recently published articles that have discussed using beta-blockers as a promising treatment to decrease mortality in critically ill patients, such as patients with septic shock, traumatic brain injury, cardiogenic shock, acute decompensated heart failure, and electrical storm. We also discuss the potential pathophysiology of beta-blockers in various types of critical illness. More clinical trials are encouraged to evaluate the safety and effectiveness of beta-blockers in improving mortality among critically ill patients.<\/jats:p>","DOI":"10.3390\/ijms25158058","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T15:47:32Z","timestamp":1721836052000},"page":"8058","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Beta-Blockers as an Immunologic and Autonomic Manipulator in Critically Ill Patients: A Review of the Recent Literature"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4219-3659","authenticated-orcid":false,"given":"Akram M.","family":"Eraky","sequence":"first","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"},{"name":"Medical Education Department, Kansas City University, Kansas City, MO 64106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashwanth","family":"Yerramalla","sequence":"additional","affiliation":[{"name":"Critical Care Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Khan","sequence":"additional","affiliation":[{"name":"Critical Care Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Mokhtar","sequence":"additional","affiliation":[{"name":"Critical Care Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Alamrosy","sequence":"additional","affiliation":[{"name":"Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Medical Research Institute, Alexandria University, Alexandria 5422031, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Farag","sequence":"additional","affiliation":[{"name":"Critical Care Medicine, Portsmouth University Hospital, Portsmouth PO6 3LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisha","family":"Wright","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Grounds","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Gregorich","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/B978-0-444-64032-1.00027-8","article-title":"Basics of Autonomic Nervous System Function","volume":"Volume 160","author":"Gibbons","year":"2019","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/978-3-031-26163-3_3","article-title":"Effects of Adrenergic Receptor Stimulation on Human Hemostasis: A Systematic Review","volume":"Volume 1408","author":"Simon","year":"2023","journal-title":"Advances in Molecular Pathology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/00004691-199301000-00002","article-title":"Functional Anatomy of the Autonomic Nervous System","volume":"10","author":"Shields","year":"1993","journal-title":"J. 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