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“Are ICU staff following standard ICU protocols when administering Metoprolol? Should Metoprolol be withheld due to low heart rate?” That is one of the questions that one of our clients had this week and I’m going to answer it.

My name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care.

So, one of our clients asked us to do a medical record review for their loved one in ICU. Like I said, one of the questions that the client had amongst many others is, “Did the ICU staff follow standard ICU protocols when administering Metoprolol? Should the Metoprolol be withheld due to low heart rate?” 

So, let’s look at this question and answer now.

So, the ICU records state that Metoprolol 12.5 mg was ordered twice daily and as needed as a PRN (as it is needed) intravenous bolus. The administration instruction included hold parameters to withhold the drug if systolic blood pressure was less than 100 millimeter per mercury, or the heart rate was less than 50 beats per minute, which is consistent with established critical care practices and safe prescribing protocols for beta blockers. Metoprolol is classified as a beta blocker.

What we found in the medical records is that charted vital signs show blood pressure fluctuations with several readings falling into the low normal or hypotensive range. The patient’s blood pressure was recorded at 96/55 millimeter of mercury, and the heart rate decreased to 57 beats per minute with other readings in the low 60s. These values for close to or within the defined hold parameters and raise concerns, especially considering the patient’s comorbidities, which included severe malnutrition, sepsis, ventilator dependency, and increased risk for hypotension. Hypotension means low blood pressure. There is no documentation confirming whether the Metoprolol was withheld or adjusted in response to these values.

In ICU level or critical acuity care, medications affecting heart rate and blood pressure require real-time clinical judgement adjustment and documentation to demonstrate safe administration.

Now, generally speaking, ICU staff are expected to follow standard protocols when administering Metoprolol or other beta-blockers and holding the medication due to low heart rate, which is also known as bradycardia, and it’s a common and appropriate clinical decision based on those protocols.

Standard ICU considerations for Metoprolol are to control the heart rate, to lower blood pressure, reduce myocardial oxygen demand, especially after a heart attack and treat arrhythmias like atrial fibrillation or tachycardia.

So, when is Metoprolol typically withheld? 

It may be withheld or dose reduced if the patient has bradycardia, heart rate typically below 50 to 60 beats per minute, depending on clinical judgment, i.e., blood pressure as well, hypotension, systolic blood pressure usually below 90 millimeter per mercury, 100 millimeter per mercury. Sometimes I’ve seen heart block or conduction abnormalities as well, especially when they’re new, signs of poor perfusion, altered mental status, or worsening organ function.

ICU protocols, many ICUs follow specific hold parameters for beta blockers, which are often written into the medication administration record. Example, parameters might be holding Metoprolol if heart rate is less than 50, 55, or 60 beats per minute and systolic blood pressure is less than 100 or 90 millimeter per mercury, again it depends on the patient.

ICU nurses usually check vitals prior to administration, and we document the reason for holding. If parameters are not met, they may also notify the attending physician or ICU team to adjust the plan.

Well, the bottom line here is that if ICU staff are holding Metoprolol due to low heart rate that typically aligns with standard safety protocols. However, if you’re concerned about inconsistency or lack of communication, you can and need to request from your treating team for your loved one a clear explanation of the whole parameters. A discussion with the ICU team about medication adjustments or alternatives.

Also, you need to get access to the medical records as soon as possible because without you having access to the medical records, you’re basically flying blind. Without you having access to the medical records and without getting a second opinion and having someone evaluate your medical records in real time like we do here at intensivecarehotline.com, you’re basically flying blind. You can’t really afford flying blind when your loved one is critically ill in intensive care.

I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse unit manager for over 5 years in intensive care and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients and families in intensive care. You can verify that on our intensivecarehotline.com testimonial section where you can read what our clients say and you can also verify it on our intensivecarehotline.com podcast section where we’ve done client interviews because our advice here is absolutely life changing.

It is absolutely life changing, that’s why you can join a growing number of clients and members because we have helped hundreds and hundreds of members and clients over the years to improve their lives instantly when they have a loved one critically ill in intensive care because once you get advice from us, you will find that you’re uncovering things that you didn’t even know.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care and that is exactly what you’re up against if you’re watching this video.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation, and you simply can’t afford to get wrong. I also talk to doctors and nurses directly on your behalf or with you. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area via email, and we answer all questions intensive care related. In the membership, you also have access to me and my team 24 hours a day in a membership area and via email, we answer all questions intensive care related. You also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, make sure your loved one gets the best care and treatment always.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have.

I also do a weekly YouTube Live where I answer your questions live on the show. You will get notification for the YouTube live, if you are a subscriber to my YouTube channel or if you’re a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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