Abstract
BACKGROUND: In critically ill patients, induction with etomidate is hypothesized to be associated with an increased risk of mortality. Previous randomized studies suggest a modest trend toward an increased risk of death among etomidate recipients; however, this relationship has not been measured with great statistical precision. We aimed to test whether etomidate is associated with risk of hospital mortality and other clinical outcomes in critically ill patients. METHODS: We conducted a retrospective cohort study from January 1, 2001, to December 31, 2005, of 824 subjects requiring mechanical ventilation, who underwent adrenal function testing in the ICUs of 2 academic medical centers. The primary outcome was in-hospital mortality, comparing subjects given etomidate (n = 452) to those given an alternative induction agent (n = 372). The secondary outcome was diagnosis of critical illness-related corticosteroid insufficiency following etomidate exposure. RESULTS: Overall mortality was 34.3%. After adjustment for age, sex, and baseline illness severity, the relative risk of death among the etomidate recipients was higher than that of subjects given an alternative agent (relative risk 1.20, 95% CI 0.99-1.45). Among subjects whose adrenal function was assessed within the 48 hours following intubation, the adjusted risk of meeting the criteria for critical illness-related corticosteroid insufficiency was 1.37 (95% CI 1.12-1.66), comparing etomidate recipients to subjects given another induction agent. CONCLUSIONS: In this study of critically ill patients requiring endotracheal intubation, etomidate administration was associated with a trend toward a relative increase in mortality, similar to the collective results of smaller randomized trials conducted to date. If a small relative increased risk is truly present, though previous trials have been underpowered to detect it, in absolute terms the number of deaths associated with etomidate in this high-risk population would be considerable. Large, prospective controlled trials are needed to finalize the role of etomidate in critically ill patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 639-646 |
| Number of pages | 8 |
| Journal | Respiratory Care |
| Volume | 58 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2013 |
| Externally published | Yes |
Fingerprint
Keywords
- Adrenal function
- Etomidate
- ICU
- Mortality
- Rapid sequence induction
- Sepsis
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
Cite this
Etomidate, adrenal function, and mortality in critically ill patients. / Sunshine, Jacob E.; Deem, Steven; Weiss, Noel S.; Yanez, Norbert; Daniel, Stephen; Keech, Katherine; Brown, Marcia; Treggiari, Miriam.
In: Respiratory Care, Vol. 58, No. 4, 01.04.2013, p. 639-646.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Etomidate, adrenal function, and mortality in critically ill patients
AU - Sunshine, Jacob E.
AU - Deem, Steven
AU - Weiss, Noel S.
AU - Yanez, Norbert
AU - Daniel, Stephen
AU - Keech, Katherine
AU - Brown, Marcia
AU - Treggiari, Miriam
PY - 2013/4/1
Y1 - 2013/4/1
N2 - BACKGROUND: In critically ill patients, induction with etomidate is hypothesized to be associated with an increased risk of mortality. Previous randomized studies suggest a modest trend toward an increased risk of death among etomidate recipients; however, this relationship has not been measured with great statistical precision. We aimed to test whether etomidate is associated with risk of hospital mortality and other clinical outcomes in critically ill patients. METHODS: We conducted a retrospective cohort study from January 1, 2001, to December 31, 2005, of 824 subjects requiring mechanical ventilation, who underwent adrenal function testing in the ICUs of 2 academic medical centers. The primary outcome was in-hospital mortality, comparing subjects given etomidate (n = 452) to those given an alternative induction agent (n = 372). The secondary outcome was diagnosis of critical illness-related corticosteroid insufficiency following etomidate exposure. RESULTS: Overall mortality was 34.3%. After adjustment for age, sex, and baseline illness severity, the relative risk of death among the etomidate recipients was higher than that of subjects given an alternative agent (relative risk 1.20, 95% CI 0.99-1.45). Among subjects whose adrenal function was assessed within the 48 hours following intubation, the adjusted risk of meeting the criteria for critical illness-related corticosteroid insufficiency was 1.37 (95% CI 1.12-1.66), comparing etomidate recipients to subjects given another induction agent. CONCLUSIONS: In this study of critically ill patients requiring endotracheal intubation, etomidate administration was associated with a trend toward a relative increase in mortality, similar to the collective results of smaller randomized trials conducted to date. If a small relative increased risk is truly present, though previous trials have been underpowered to detect it, in absolute terms the number of deaths associated with etomidate in this high-risk population would be considerable. Large, prospective controlled trials are needed to finalize the role of etomidate in critically ill patients.
AB - BACKGROUND: In critically ill patients, induction with etomidate is hypothesized to be associated with an increased risk of mortality. Previous randomized studies suggest a modest trend toward an increased risk of death among etomidate recipients; however, this relationship has not been measured with great statistical precision. We aimed to test whether etomidate is associated with risk of hospital mortality and other clinical outcomes in critically ill patients. METHODS: We conducted a retrospective cohort study from January 1, 2001, to December 31, 2005, of 824 subjects requiring mechanical ventilation, who underwent adrenal function testing in the ICUs of 2 academic medical centers. The primary outcome was in-hospital mortality, comparing subjects given etomidate (n = 452) to those given an alternative induction agent (n = 372). The secondary outcome was diagnosis of critical illness-related corticosteroid insufficiency following etomidate exposure. RESULTS: Overall mortality was 34.3%. After adjustment for age, sex, and baseline illness severity, the relative risk of death among the etomidate recipients was higher than that of subjects given an alternative agent (relative risk 1.20, 95% CI 0.99-1.45). Among subjects whose adrenal function was assessed within the 48 hours following intubation, the adjusted risk of meeting the criteria for critical illness-related corticosteroid insufficiency was 1.37 (95% CI 1.12-1.66), comparing etomidate recipients to subjects given another induction agent. CONCLUSIONS: In this study of critically ill patients requiring endotracheal intubation, etomidate administration was associated with a trend toward a relative increase in mortality, similar to the collective results of smaller randomized trials conducted to date. If a small relative increased risk is truly present, though previous trials have been underpowered to detect it, in absolute terms the number of deaths associated with etomidate in this high-risk population would be considerable. Large, prospective controlled trials are needed to finalize the role of etomidate in critically ill patients.
KW - Adrenal function
KW - Etomidate
KW - ICU
KW - Mortality
KW - Rapid sequence induction
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=84876168007&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876168007&partnerID=8YFLogxK
U2 - 10.4187/respcare.01956
DO - 10.4187/respcare.01956
M3 - Article
C2 - 22906838
AN - SCOPUS:84876168007
VL - 58
SP - 639
EP - 646
JO - Respiratory Care
JF - Respiratory Care
SN - 0020-1324
IS - 4
ER -