Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis.
Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis.
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DOI：
10.1186/cc11871
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发表时间：
2012-11-21
期刊：
影响因子：
--
通讯作者：
Jaber S
中科院分区：
文献类型：
--
作者：
Jung B;Clavieras N;Nougaret S;Molinari N;Roquilly A;Cisse M;Carr J;Chanques G;Asehnoune K;Jaber S
ICU气管插管并发症发生率高。依托咪酯在脓毒性休克中的应用存在争议，因为它增加了危重疾病相关的皮质类固醇不足的风险，这可能会影响结局。我们假设，氢化可的松，在我们的ICU所有感染性休克病例中使用，可能会抵消依托咪酯的一些负面影响。本研究的目的是比较接受依托咪酯与另一种诱导药物的脓毒性休克患者的短期安全性和长期结局。在感染性休克患者中进行了一项单中心观察性研究，在感染性休克的前48小时内接受氢化可的松治疗并插管。共同主要终点为插管后1小时内发生的危及生命的并发症和ICU住院期间的死亡率。统计分析包括使用倾向评分分析的不匹配和匹配队列。P < 0.05被认为是有意义的。依托咪酯队列中有60例患者，非依托咪酯队列中有42例患者。依托咪酯组和非依托咪酯组的危重病相关皮质类固醇不足分别为79%和52%（P = 0.01）。插管后，36%的患者发生危及生命的并发症，无论队列如何。在用倾向评分分析调整后，依托咪酯是ICU死亡的保护因素，无论是在非匹配组（风险比，0.33（0.15 - 0.75）; P < 0.01）还是匹配组（风险比，0.33（0.112 - 0.988）; P = 0.04）。在接受氢化可的松治疗的感染性休克患者中，依托咪酯并不能减少插管后危及生命的并发症，但与氢化可的松联合使用时，依托咪酯也不会损害预后。
Endotracheal intubation in the ICU is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock cases in our ICU, may counteract some negative effects of etomidate. The aim of our study was to compare septic shock patients who received etomidate versus another induction drug both for short-term safety and for long-term outcomes. A single-center observational study was carried out in septic shock patients, treated with hydrocortisone and intubated within the first 48 hours of septic shock. Co-primary end points were life-threatening complications incidence occurring within the first hour after intubation and mortality during the ICU stay. Statistical analyses included unmatched and matched cohorts using a propensity score analysis. P < 0.05 was considered significant. Sixty patients in the etomidate cohort and 42 patients in the non-etomidate cohort were included. Critical illness-related corticosteroid insufficiency was 79% in the etomidate cohort and 52% in the non-etomidate cohort (P = 0.01). After intubation, life-threatening complications occurred in 36% of the patients whatever the cohort. After adjustment with propensity score analysis, etomidate was a protective factor for death in the ICU both in unmatched (hazard ratio, 0.33 (0.15 to 0.75); P < 0.01)) and matched cohorts (hazard ratio, 0.33 (0.112 to 0.988); P = 0.04). In septic shock patients treated with hydrocortisone, etomidate did not decrease life-threatening complications following intubation, but when associated with hydrocortisone it also did not impair outcome.
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DOI：
10.1164/rccm.200509-1507oc
发表时间：
2006-07-15
影响因子：
24.7
作者：
Baillard, Christophe;Fosse, Jean-Philippe;Jaber, Samir
通讯作者：
Jaber, Samir
影响因子：
6.2
作者：
Gilbert, EH;Lowenstein, SR;Steiner, J
通讯作者：
Steiner, J
影响因子：
3.2
作者：
de Jong, Margriet F. C.;Beishuizen, Albertus;Groeneveld, A. B. Johan
通讯作者：
Groeneveld, A. B. Johan
DOI：
10.1097/ta.0b013e31818255e8
发表时间：
2008-09-01
影响因子：
--
作者：
Hildreth, Amy N.;Mejia, Vicente A.;Barker, Donald E.
通讯作者：
Barker, Donald E.
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