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Etomidate and mortality in cirrhotic patients with septic shock.

Cherfan AJ, Tamim HM, AlJumah A, Rishu AH, Al-Abdulkareem A, Al Knawy BA, Hajeer A, Tamimi W, Brits R, Arabi YM - BMC Clin Pharmacol (2011)

Bottom Line: Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02).Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements.The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pharmaceutical Care Department, Clinical Pharmacy Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

ABSTRACT

Background: Clinical effects and outcomes of a single dose etomidate prior to intubation in the intensive care setting is controversial. The aim of this study is to evaluate the association of a single dose effect of etomidate prior to intubation on the mortality of septic cirrhotic patients and the impact of the subsequent use of low dose hydrocortisone.

Methods: This is a nested-cohort study within a randomized double blind placebo controlled study evaluating the use of low dose hydrocortisone in cirrhotic septic patients. Cirrhotic septic patients ≥ 18 years were included in the study. Patients who received etomidate prior to intubation were compared to those who did not receive etomidate for all cause 28-day mortality as a primary outcome.

Results: Sixty two intubated patients out of the 75 patients randomized in the initial trial were eligible for this study. Twenty three of the 62 intubated patients received etomidate dose prior to intubation. Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02). Etomidate patients who received subsequent doses of hydrocortisone required lower doses of vasopressors and had more vasopressor-free days but no improvement in mortality.

Conclusions: In this group of septic cirrhotic patients with very high mortality, etomidate increased ICU mortality. Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements. The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.

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Mortality with etomidate vs. control stratified by hydrocortisone use.
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Figure 1: Mortality with etomidate vs. control stratified by hydrocortisone use.

Mentions: However, the use of hydrocortisone vs. placebo in the etomidate group was associated with more vasopressor-free days (4.6 ± 6.93 vs. 1.1 ± 3.3; p = 0.05); lower vasopressor requirements measured by delta norepinephrine (day3-day1) (-0.10 ± 0.26 vs. 0.31 ± 0.36; p = 0.01); and more ventilation-free days (3.6 ± 5.6 vs.0.2 ± 0.4; p = 0.04). (Table 3, Figure 1)


Etomidate and mortality in cirrhotic patients with septic shock.

Cherfan AJ, Tamim HM, AlJumah A, Rishu AH, Al-Abdulkareem A, Al Knawy BA, Hajeer A, Tamimi W, Brits R, Arabi YM - BMC Clin Pharmacol (2011)

Mortality with etomidate vs. control stratified by hydrocortisone use.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3295685&req=5

Figure 1: Mortality with etomidate vs. control stratified by hydrocortisone use.
Mentions: However, the use of hydrocortisone vs. placebo in the etomidate group was associated with more vasopressor-free days (4.6 ± 6.93 vs. 1.1 ± 3.3; p = 0.05); lower vasopressor requirements measured by delta norepinephrine (day3-day1) (-0.10 ± 0.26 vs. 0.31 ± 0.36; p = 0.01); and more ventilation-free days (3.6 ± 5.6 vs.0.2 ± 0.4; p = 0.04). (Table 3, Figure 1)

Bottom Line: Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02).Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements.The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pharmaceutical Care Department, Clinical Pharmacy Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

ABSTRACT

Background: Clinical effects and outcomes of a single dose etomidate prior to intubation in the intensive care setting is controversial. The aim of this study is to evaluate the association of a single dose effect of etomidate prior to intubation on the mortality of septic cirrhotic patients and the impact of the subsequent use of low dose hydrocortisone.

Methods: This is a nested-cohort study within a randomized double blind placebo controlled study evaluating the use of low dose hydrocortisone in cirrhotic septic patients. Cirrhotic septic patients ≥ 18 years were included in the study. Patients who received etomidate prior to intubation were compared to those who did not receive etomidate for all cause 28-day mortality as a primary outcome.

Results: Sixty two intubated patients out of the 75 patients randomized in the initial trial were eligible for this study. Twenty three of the 62 intubated patients received etomidate dose prior to intubation. Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02). Etomidate patients who received subsequent doses of hydrocortisone required lower doses of vasopressors and had more vasopressor-free days but no improvement in mortality.

Conclusions: In this group of septic cirrhotic patients with very high mortality, etomidate increased ICU mortality. Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements. The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.

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