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Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine Among Critically Ill Patients.
Wunsch, Hannah; Bosch, Nicholas A; Law, Anica C; Vail, Emily A; Hua, May; Shen, Burton H; Lindenauer, Peter K; Juurlink, David N; Walkey, Allan J; Gershengorn, Hayley B.
Afiliación
  • Wunsch H; Weill Cornell Medical College, Department of Anesthesiology, New York, New York, United States; haw9006@med.cornell.edu.
  • Bosch NA; Boston University School of Medicine, Department of Medicine, The Pulmonary Center, Boston, Massachusetts, United States.
  • Law AC; Boston Medical Center, Medicine, Boston, Massachusetts, United States.
  • Vail EA; University of Pennsylvania, Anesthesiology & Critical Care, Philadelphia, Pennsylvania, United States.
  • Hua M; Columbia University, New York, United States.
  • Shen BH; Boston Medical Center, Pulmonary, Boston, Massachusetts, United States.
  • Lindenauer PK; Baystate Medical Center, Center for Quality of Care Research, Springfield, Massachusetts, United States.
  • Juurlink DN; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
  • Walkey AJ; UMass Chan Medical School, Health Systems Science, Worcester, Massachusetts, United States.
  • Gershengorn HB; University of Miami School of Medicine, Miami, Florida, United States.
Am J Respir Crit Care Med ; 2024 Aug 22.
Article en En | MEDLINE | ID: mdl-39173173
ABSTRACT
RATIONALE Uncertainty remains regarding the risks associated with single dose use of etomidate.

OBJECTIVES:

To assess use of etomidate in critically ill patients and compare outcomes for patients who received etomidate versus ketamine.

METHODS:

We assessed patients who received invasive mechanical ventilation (IMV), admitted to an ICU in the Premier Healthcare Database, 2008-2021. The exposure was receipt of etomidate on the day of IMV initiation and the main outcome was hospital mortality. Using multivariable regression we compared patients who received IMV within the first two days of hospitalization who received etomidate with propensity-score matched patients who received ketamine. We also assessed whether receipt of corticosteroids in the days after intubation modified the association between etomidate and mortality. MEASUREMENTS AND MAIN

RESULTS:

Of 1,689,945 patients who received IMV, nearly half (738,855; 43.7%) received etomidate. Among those who received IMV in the first two days of hospitalization, we established 22,273 matched pairs given either etomidate or ketamine. In the primary analysis, receipt of etomidate was associated with greater hospital mortality relative to ketamine (21.6% vs 18.7%; absolute risk difference 2.8%, 95% CI 2.1%, 3.6%; adjusted odds ratio 1.28, 95% CI 1.21,1.34). This was consistent across subgroups and sensitivity analyses. We found no attenuation of the association with mortality with receipt of corticosteroids in the days following etomidate use.

CONCLUSIONS:

Use of etomidate on the day of IMV initiation is common and associated with a higher odds of hospital mortality compared with ketamine. This finding is independent of subsequent treatment with corticosteroids.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos