Etomidate use in severe sepsis and septic shock patients does not contribute to mortality
Etomidate use in severe sepsis and septic shock patients does not contribute to mortality
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DOI：
10.1007/s11739-011-0553-3
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发表时间：
2011-06-01
影响因子：
4.6
通讯作者：
Mullen, Marie
中科院分区：
文献类型：
--
作者：
Ehrman, Robert;Wira, Charles;Mullen, Marie
依托咪酯在严重脓毒症和感染性休克中的应用在最近的文献中受到了挑战，因为它与肾上腺功能不全和可疑的死亡率增加有关。我们假设依托咪酯不会增加这类患者的死亡率。对2001年12月至2009年10月期间在两个大学三级护理转诊中心接受治疗的230名插管、严重败血症/感染性休克患者进行了回顾性图表回顾。主要终点是住院死亡率。其他被调查的变量包括皮质类固醇的使用、医院和重症监护病房(ICU)的住院时间、机械通气天数和患者人口统计学。173名患者接受依托咪酯治疗，57名患者不接受药物治疗或接受替代药物治疗。在该患者队列中使用依托咪酯并未使死亡率恶化。依托咪酯组死亡率为43.9%(76/173)。非依托咪酯组的死亡率为45.6%(26/57)(p=0.48)。依托咪酯组和非依托咪酯组的APACHE II评分分别为22+/-A 7.2和23+/-A 7.1(p=0.36)。在这项研究中，依托咪酯和非依托咪酯队列的死亡率没有显著差异。这项大型多中心回顾性研究进一步支持依托咪酯治疗严重败血症和感染性休克的安全性。
Use of etomidate in severe sepsis and septic shock has been challenged in recent literature due to its link to adrenal insufficiency and suspected increased mortality. We hypothesized that etomidate does not contribute to mortality in this patient population. A retrospective chart review of 230 intubated, severe sepsis/septic shock patients at two university tertiary care referral centers was conducted for patients receiving treatment between 12/2001 and 10/2009. The primary endpoint was in-hospital mortality. Additional investigated variables included the use of corticosteroids, hospital and intensive care unit (ICU) length of stay, mechanical ventilation days and patient demographics. One hundred seventy-three patients received etomidate and fifty-seven patients received either no medication or an alternative drug. Use of etomidate in this patient cohort did not worsen mortality. Mortality in the etomidate group was 43.9% (76/173). Mortality in the non-etomidate cohort was 45.6% (26/57) (p = 0.48). APACHE II scores were 22 +/- A 7.2 and 23 +/- A 7.1 for the etomidate group and the non-etomidate group, respectively, (p = 0.36). There was no significant difference in mortality between etomidate and non-etomidate cohorts in this study. This large retrospective multi-center study further supports the safety of etomidate use in severe sepsis and septic shock.