Single-Dose Etomidate Is Not Associated With Increased Mortality in ICU Patients With Sepsis: Analysis of a Large Electronic ICU Database
Single-Dose Etomidate Is Not Associated With Increased Mortality in ICU Patients With Sepsis: Analysis of a Large Electronic ICU Database
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DOI：
10.1097/ccm.0b013e318274190d
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发表时间：
2013-03-01
影响因子：
8.8
通讯作者：
Seder, David B.
中科院分区：
文献类型：
--
作者：
McPhee, Laura C.;Badawi, Omar;Seder, David B.
目的：对几项试验的回顾性分析表明，依托咪酯用于脓毒症患者的插管可能不安全。我们评估了依托咪酯与脓毒症患者死亡率之间的关系，以确定单剂量依托咪酯是否与院内死亡率增加相关。设计和设置：在Philips elCU研究所ICU临床数据库中进行的回顾性队列研究。干预措施：无。患者：在2008年至2010年监测的741，036例患者中，我们确定了2，014例在ICU入院后4-96小时插管的成人，其临床标准与脓毒症，严重脓毒症或脓毒性休克一致。在所有的，1,102例患者接受依托咪酯和912接受其他诱导剂intubation.Measurements和主要结果：主要终点是在医院死亡率，但我们也评估了人口统计学和临床因素，疾病的严重程度，ICU死亡率，ICU住院时间，住院时间，呼吸机天数和血管加压药天数。竞争风险考克斯比例风险回归模型用于主要结局。两组之间的人口统计学和疾病严重程度相似。两组的住院死亡率相似（37.2% vs. 37.8%，p = 0.77），ICU死亡率相似（30.1% vs. 30.2%，p = 0.99），ICU住院时间相似（8.7天vs. 8.9天，p = 0.66），住院时间相似（15.2天vs. 14.6天，p = 0.31）。依托咪酯组更多的患者在插管前后接受类固醇治疗（52.9% vs. 44.5%，p < 0.001），但血管加压药的使用和机械通气的持续时间相似。没有回归模型显示依托咪酯与死亡率、休克、机械通气持续时间、ICU或住院时间或血管加压药使用独立相关。仅限于感染性休克患者（n = 650）的医院死亡率模型也显示依托咪酯和医院mortality.Conclusion：在混合诊断组的危重患者脓毒症，严重脓毒症和感染性休克，单剂量依托咪酯管理插管在ICU与较高的死亡率或其他不良临床结局无关。(Crit Care Med 2013; 41：774-783）
Objective: Retrospective analyses of several trials suggest etomidate may be unsafe for intubation in patients with sepsis. We evaluated the association of etomidate and mortality in a large cohort of septic patients to determine if single-dose etomidate was associated with increased in-hospital mortality.Design and Setting: Retrospective cohort study at the Philips elCU Research Institute ICU clinical database.Interventions: None.Patients: Among 741,036 patients monitored from 2008 through 2010, we identified 2,014 adults intubated in the ICU 4-96 hrs after admission, having clinical criteria consistent with sepsis, severe sepsis, or septic shock. In all, 1,102 patients received etomidate and 912 received other induction agents for intubation.Measurements and Main Results: The primary endpoint was in-hospital mortality, but we also evaluated demographic and clinical factors, severity of illness, ICU mortality, ICU length of stay, hospital length of stay, ventilator days, and vasopressor days. Competing risk Cox proportional hazard regression models were used for primary outcomes. Demographics and illness severity were similar between the groups. Hospital mortality was similar between the groups (37.2% vs. 37.8%, p = 0.77), as were ICU mortality (30.1% vs. 30.2%, p = 0.99), ICU length of stay (8.7 days vs. 8.9 days, p = 0.66), and hospital length of stay (15.2 vs. 14.6 days, p = 0.31). More patients in the etomidate group received steroids before and after intubation (52.9% vs. 44.5%, p < 0.001), but vasopressor use and duration of mechanical ventilation were similar. No regression model showed an independent association of etomidate with mortality, shock, duration of mechanical ventilation, ICU or hospital length of stay, or vasopressor use. A hospital mortality model limited to only patients with septic shock (n = 650) also showed no association of etomidate and hospital mortality.Conclusion: In a mixed-diagnosis group of critically ill patients with sepsis, severe sepsis, and septic shock, single-dose etomidate administration for intubation in the ICU was not associated with higher mortality or other adverse clinical Outcomes. (Crit Care Med 2013; 41:774-783)