Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysisReport as inadecuate




Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 16:R224

First Online: 21 November 2012Received: 28 May 2012Revised: 02 August 2012Accepted: 12 November 2012

Abstract

IntroductionEndotracheal 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.

MethodsA 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.

ResultsSixty 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.

ConclusionIn 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.

AbbreviationsCIRCIcritical illness-related corticosteroid insufficiency.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11871 contains supplementary material, which is available to authorized users.

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Author: Boris Jung - Noemie Clavieras - Stephanie Nougaret - Nicolas Molinari - Antoine Roquilly - Moussa Cisse - Julie Carr - Gera

Source: https://link.springer.com/







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