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Single-Dose Etomidate Is Not Associated With Increased Mortality in ICU Patients With Sepsis: Analysis of a Large Electronic ICU Database*

McPhee, Laura C. DO1; Badawi, Omar PharmD, MPH2,3; Fraser, Gilles L. PharmD, FCCM4,5; Lerwick, Patricia A. MD1,5; Riker, Richard R. MD, FCCM1,2,5; Zuckerman, Ilene H. PharmD, PhD6; Franey, Christine MPH6; Seder, David B. MD, FCCP1,5

doi: 10.1097/CCM.0b013e318274190d
Clinical Investigations

Objective: Retrospective analyses of several trials suggest etomidate may be unsafe for intubation in patients with sepsis. We evaluated the association of etomidate and mortality in a large cohort of septic patients to determine if single-dose etomidate was associated with increased in-hospital mortality.

Design and Setting: Retrospective cohort study at the Philips eICU Research Institute ICU clinical database.

Interventions: None.

Patients: Among 741,036 patients monitored from 2008 through 2010, we identified 2,014 adults intubated in the ICU 4–96 hrs after admission, having clinical criteria consistent with sepsis, severe sepsis, or septic shock. In all, 1,102 patients received etomidate and 912 received other induction agents for intubation.

Measurements and Main Results: The primary endpoint was in-hospital mortality, but we also evaluated demographic and clinical factors, severity of illness, ICU mortality, ICU length of stay, hospital length of stay, ventilator days, and vasopressor days. Competing risk Cox proportional hazard regression models were used for primary outcomes. Demographics and illness severity were similar between the groups. Hospital mortality was similar between the groups (37.2% vs. 37.8%, p = 0.77), as were ICU mortality (30.1% vs. 30.2%, p = 0.99), ICU length of stay (8.7 days vs. 8.9 days, p = 0.66), and hospital length of stay (15.2 vs. 14.6 days, p = 0.31). More patients in the etomidate group received steroids before and after intubation (52.9% vs. 44.5%, p < 0.001), but vasopressor use and duration of mechanical ventilation were similar. No regression model showed an independent association of etomidate with mortality, shock, duration of mechanical ventilation, ICU or hospital length of stay, or vasopressor use. A hospital mortality model limited to only patients with septic shock (n = 650) also showed no association of etomidate and hospital mortality.

Conclusion: In a mixed-diagnosis group of critically ill patients with sepsis, severe sepsis, and septic shock, single-dose etomidate administration for intubation in the ICU was not associated with higher mortality or other adverse clinical outcomes.

1 Division of Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME.

2 Philips Healthcare, Baltimore, MD.

3 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.

4 Department of Pharmacy, Maine Medical Center, Portland, ME.

5 Department of Critical Care Services, Maine Medical Center, Portland, ME.

6 Department of Pharmaceutical Health Services Research, Pharmaceutical Research Computing Center, University of Maryland School of Pharmacy, Baltimore, MD.

* See also p. 917.

Dr. Badawi is an employee of Philips Healthcare. Dr Zuckerman is principle investigator on a contract with Phillips Healthcare to provide analytic support for this research. The remaining authors have not disclosed any potential conflicts of interest.

Supported by a grant from Philips Healthcare.

For information regarding this article, E-mail: sederd@mmc.org

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins