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Outcomes of etomidate in severe sepsis and septic shock.
Chest. 2010 Dec; 138(6):1327-32.Chest

Abstract

BACKGROUND

The use of single-dose etomidate to facilitate intubation in critically ill patients has recently been debated given its suppression of steroidogenesis with possible resultant adverse outcomes. Our objective was to assess the effects of single-dose etomidate used during rapid-sequence intubation (RSI) on various measures of outcome, such as mortality, vasopressor use, corticosteroid use, ICU length of stay (ICU-LOS), and number of ventilator days.

METHODS

A retrospective 18-month cohort study was performed in a multidisciplinary ICU of an academic tertiary care institution. Consecutive patients with severe sepsis or septic shock who were intubated and mechanically ventilated were identified and grouped as having received single-dose etomidate during intubation or not. Hospital mortality, ICU length of stay, number of ventilator days, corticosteroid use, vasopressor use, and demographic and clinical variables were recorded.

RESULTS

Two hundred twenty-four patients were identified; 113 had received etomidate. The mean Acute Physiology and Chronic Health Evaluation II scores in the etomidate and nonetomidate groups were 21.3 ± 8.1 and 21.9 ± 8.3, respectively (P = .62). The relative risks for mortality and vasopressor use were 0.92 (CI, 0.74-1.14; P = 0.51) and 1.16 (CI, 0.9-1.51; P = .31), respectively, in the etomidate group. There were no significant differences in ICU-LOS (mean, 14 vs 12 days; P = .31) or number of ventilator days (mean, 11 vs 8 days; P = .13) between the etomidate and nonetomidate groups, respectively. The relative risk for corticosteroid use in the etomidate group was 1.34 (CI, 1.11-1.61; P = .003). Multivariate analysis using logistic regression demonstrated no significant association of etomidate with mortality (OR, 0.9; CI, 0.45-1.83; P = .78).

CONCLUSION

Single-dose etomidate used during RSI in critically ill patients with severe sepsis and septic shock was not associated with increased mortality, vasopressor use, ICU-LOS, or number of ventilator days. Patients intubated with etomidate had an increased incidence of subsequent corticosteroid use, with no difference in outcomes.

Authors+Show Affiliations

Division of Pulmonary, Critical Care, and Sleep Medicine, Saint Louis University Hospital, Louis, MO 63104, USA. ddmello@slu.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20651024

Citation

Dmello, Dayton, et al. "Outcomes of Etomidate in Severe Sepsis and Septic Shock." Chest, vol. 138, no. 6, 2010, pp. 1327-32.
Dmello D, Taylor S, O'Brien J, et al. Outcomes of etomidate in severe sepsis and septic shock. Chest. 2010;138(6):1327-32.
Dmello, D., Taylor, S., O'Brien, J., & Matuschak, G. M. (2010). Outcomes of etomidate in severe sepsis and septic shock. Chest, 138(6), 1327-32. https://doi.org/10.1378/chest.10-0790
Dmello D, et al. Outcomes of Etomidate in Severe Sepsis and Septic Shock. Chest. 2010;138(6):1327-32. PubMed PMID: 20651024.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of etomidate in severe sepsis and septic shock. AU - Dmello,Dayton, AU - Taylor,Stephen, AU - O'Brien,Jacklyn, AU - Matuschak,George M, Y1 - 2010/07/22/ PY - 2010/7/24/entrez PY - 2010/7/24/pubmed PY - 2011/1/14/medline SP - 1327 EP - 32 JF - Chest JO - Chest VL - 138 IS - 6 N2 - BACKGROUND: The use of single-dose etomidate to facilitate intubation in critically ill patients has recently been debated given its suppression of steroidogenesis with possible resultant adverse outcomes. Our objective was to assess the effects of single-dose etomidate used during rapid-sequence intubation (RSI) on various measures of outcome, such as mortality, vasopressor use, corticosteroid use, ICU length of stay (ICU-LOS), and number of ventilator days. METHODS: A retrospective 18-month cohort study was performed in a multidisciplinary ICU of an academic tertiary care institution. Consecutive patients with severe sepsis or septic shock who were intubated and mechanically ventilated were identified and grouped as having received single-dose etomidate during intubation or not. Hospital mortality, ICU length of stay, number of ventilator days, corticosteroid use, vasopressor use, and demographic and clinical variables were recorded. RESULTS: Two hundred twenty-four patients were identified; 113 had received etomidate. The mean Acute Physiology and Chronic Health Evaluation II scores in the etomidate and nonetomidate groups were 21.3 ± 8.1 and 21.9 ± 8.3, respectively (P = .62). The relative risks for mortality and vasopressor use were 0.92 (CI, 0.74-1.14; P = 0.51) and 1.16 (CI, 0.9-1.51; P = .31), respectively, in the etomidate group. There were no significant differences in ICU-LOS (mean, 14 vs 12 days; P = .31) or number of ventilator days (mean, 11 vs 8 days; P = .13) between the etomidate and nonetomidate groups, respectively. The relative risk for corticosteroid use in the etomidate group was 1.34 (CI, 1.11-1.61; P = .003). Multivariate analysis using logistic regression demonstrated no significant association of etomidate with mortality (OR, 0.9; CI, 0.45-1.83; P = .78). CONCLUSION: Single-dose etomidate used during RSI in critically ill patients with severe sepsis and septic shock was not associated with increased mortality, vasopressor use, ICU-LOS, or number of ventilator days. Patients intubated with etomidate had an increased incidence of subsequent corticosteroid use, with no difference in outcomes. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/20651024/Outcomes_of_etomidate_in_severe_sepsis_and_septic_shock_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(10)60641-1 DB - PRIME DP - Unbound Medicine ER -