Association between Etomidate Use for Rapid Sequence Intubation and Adrenal Insufficiency in Sepsis.
Association between Etomidate Use for Rapid Sequence Intubation and Adrenal Insufficiency in Sepsis.
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DOI：
10.7759/cureus.13445
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发表时间：
2021-02-19
期刊：
影响因子：
--
通讯作者：
Barrera R
中科院分区：
文献类型：
--
作者：
Cagliani JA;Ruhemann A;Molmenti E;Smith C;Coppa G;Barrera R
脓毒症患者使用单剂量依托咪酯插管时肾上腺功能不全（AI）的风险仍存在争议。我们的目的是评估接受依托咪酯快速序列插管（RSI）的患者中AI的患病率并描述其风险因素。方法回顾性研究外科重症监护室（SICU）发生呼吸衰竭并接受RSI的患者的前瞻性数据。结果44例成人SICU患者发生呼吸衰竭，其中34例给予依托咪酯治疗。接受依托咪酯治疗和未接受依托咪酯治疗的患者的平均年龄分别为70.91 ± 14.92岁、72.82 ± 13.61岁和64.40 ± 15.93岁。总队列中24例患者（54.55%）发生AI; 26例患者发生脓毒性休克（59.09%），16例患者发生AI和脓毒性休克（36.36%）。接受依托咪酯治疗的患者AI发生率（47%）与未接受依托咪酯治疗的患者AI发生率（80%）之间无统计学意义，但在接受依托咪酯治疗RSI的患者亚组中，脓毒症患者AI发生率与非脓毒症患者相比无显著增加趋势（p = 0.06）。结论依托咪酯单次给药治疗SICU患者的RSI与AI的发生及死亡率无关。然而，显示了脓毒症患者发生AI的趋势，尽管没有统计学显著性。高质量和充分的随机对照试验（RCT）是必要的。
Background The risk of adrenal insufficiency (AI) in using single-dose etomidate for intubation among patients with sepsis remains controversial. Our aim was to assess the prevalence of AI and characterize the risk factors in patients who received etomidate for rapid sequence intubation (RSI). Methods This is a retrospective study of prospectively-acquired data evaluating surgical intensive care unit (SICU) patients who developed respiratory failure undergoing RSI. Results Of the 44 adult SICU patients who developed respiratory failure, 34 patients received etomidate. The average age for the total cohort, for the patients that received etomidate and for those who did not, was 70.91 ± 14.92, 72.82 ± 13.61 years and 64.40 ± 15.93, respectively. Twenty-four patients of the total cohort (54.55%) developed AI; 26 had septic shock (59.09%), and 16 patients had AI and septic shock (36.36%). There was no statistical significance between the incidence of AI in patients who received etomidate (47%) and those who did not (80%). However, in the subset of patients who received etomidate for RSI, there was a non-significant trend toward increased incidence of AI in those who were septic compared to those who were not (p = 0.06). Conclusion A single dose of etomidate used for RSI in SICU patients is not associated with the development of AI or mortality. However, a trend was shown, although not statistically significant, towards the development of AI in septic patients. High-quality and adequately powered randomized control trials (RCTs) are warranted.
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影响因子：
--
作者：
Cotton, Bryan A.;Guillamondegui, Oscar D.;Arbogast, Patrick G.
通讯作者：
Arbogast, Patrick G.
影响因子：
4.6
作者：
Ehrman, Robert;Wira, Charles;Mullen, Marie
通讯作者：
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影响因子：
38.9
作者：
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通讯作者：
Payen, Jean-Francois
影响因子：
8.8
作者：
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通讯作者：
Seder, David B.
DOI：
10.1186/cc4979
发表时间：
2006
期刊：
Critical care (London, England)
影响因子：
--
作者：
Mohammad Z;Afessa B;Finkielman JD
通讯作者：
Finkielman JD