Outcomes of etomidate in severe sepsis and septic shock
| Autor: | George M. Matuschak, Jacklyn O'Brien, Stephen Taylor, Dayton Dmello |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_treatment Critical Illness Conscious Sedation Critical Care and Intensive Care Medicine Risk Assessment Drug Administration Schedule Sepsis Cohort Studies Etomidate Reference Values medicine Intubation Intratracheal Intubation Humans Hypnotics and Sedatives Hospital Mortality APACHE Aged Retrospective Studies Aged 80 and over Academic Medical Centers business.industry Septic shock Incidence (epidemiology) Middle Aged medicine.disease Respiration Artificial Shock Septic Survival Analysis Intensive Care Units Logistic Models Treatment Outcome Anesthesia Relative risk Bacteremia Multivariate Analysis Female Cardiology and Cardiovascular Medicine business medicine.drug Cohort study Follow-Up Studies |
| Zdroj: | Chest. 138(6) |
| ISSN: | 1931-3543 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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