EBM collaborative project

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This independent website is dedicated to the integration of Evidence-Based Medicine into the everyday management of patient care. On this website you can explore how lab results can be best used to "rule-in" or "rule-out" a diagnosis. You can also explore how researchers prove or disprove the effectiveness of a therapy and what others think of recent important publications. Enjoy! 

The Colleborative Project.

2X2 table review on white board.

2X2 REVIEW ON WHITE BOARD

CCM Journal Club Abstract and Review

Outcomes of Etomidate in Severe Sepsis and Septic Shock

1. Dayton Dmello, MD, 
2. Stephen Taylor, MD, 
3. Jacklyn O’Brien, RN and
4. George M. Matuschak, MD, FCCP

+Author Affiliations

1. From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Dmello and Matuschak), Saint Louis University School of Medicine; and the Department of Critical Care Medicine (Dr Taylor and Ms O’Brien), St. John’s Mercy Medical Center, St. Louis, MO.

1. Correspondence to:
   Dayton Dmello, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, Saint Louis University Hospital, 1402 S Grand Blvd, 7 Desloge Towers, St. Louis, MO 63104; e-mail: [email protected]

Abstract

Background: The use of single-dose etomidate to facilitate intubation in critically ill patients has recently been debated given its suppression of steroidogenesis with possible resultant adverse outcomes. Our objective was to assess the effects of single-dose etomidate used during rapid-sequence intubation (RSI) on various measures of outcome, such as mortality, vasopressor use, corticosteroid use, ICU length of stay (ICU-LOS), and number of ventilator days.

Methods: A retrospective 18-month cohort study was performed in a multidisciplinary ICU of an academic tertiary care institution. Consecutive patients with severe sepsis or septic shock who were intubated and mechanically ventilated were identified and grouped as having received single-dose etomidate during intubation or not. Hospital mortality, ICU length of stay, number of ventilator days, corticosteroid use, vasopressor use, and demographic and clinical variables were recorded.

Results: Two hundred twenty-four patients were identified; 113 had received etomidate. The mean Acute Physiology and Chronic Health Evaluation II scores in the etomidate and nonetomidate groups were 21.3 ± 8.1 and 21.9 ± 8.3, respectively (P = .62). The relative risks for mortality and vasopressor use were 0.92 (CI, 0.74-1.14; P = 0.51) and 1.16 (CI, 0.9-1.51; P = .31), respectively, in the etomidate group. There were no significant differences in ICU-LOS (mean, 14 vs 12 days; P = .31) or number of ventilator days (mean, 11 vs 8 days; P = .13) between the etomidate and nonetomidate groups, respectively. The relative risk for corticosteroid use in the etomidate group was 1.34 (CI, 1.11-1.61; P = .003). Multivariate analysis using logistic regression demonstrated no significant association of etomidate with mortality (OR, 0.9; CI, 0.45-1.83; P = .78).

Conclusion: Single-dose etomidate used during RSI in critically ill patients with severe sepsis and septic shock was not associated with increased mortality, vasopressor use, ICU-LOS, or number of ventilator days. Patients intubated with etomidate had an increased incidence of subsequent corticosteroid use, with no difference in outcomes.

Footnotes