Warner Keir J, Cuschieri Joseph, Jurkovich Gregory J, Bulger Eileen M
Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA.
J Trauma. 2009 Jul;67(1):45-50. doi: 10.1097/TA.0b013e3181a92a70.
Etomidate is an induction agent used for the rapid sequence intubation (RSI) of trauma patients because of its favorable hemodynamic profile and rapid onset. However, recent studies have shown etomidate to decrease circulating cortisol concentrations, potentially influencing inflammation. We hypothesized that etomidate may alter the occurrence of acute respiratory distress syndrome (ARDS) in injury victims.
We analyzed data collected prospectively from a clinical trial of prehospital hypertonic saline administration. Post hoc, patients were grouped according to whether they did or did not receive etomidate for prehospital airway management. The incidence of ARDS was compared between the two groups by Fisher's exact test. Logistic regression was used to adjust for the effects of other known risk factors for ARDS.
Over a 2-year period, 94 study patients underwent RSI, of which 35 received etomidate (37%). There were no significant differences in demographic, physiology, anatomic injury scores, or use of hypertonic saline resuscitation between the groups. After adjusting for physiology, injury severity, and transfusion, etomidate use remained associated with ARDS (aOR = 3.9, 95% CI =1.24-12.0).
Single-dose etomidate for RSI in severely injured trauma patients is associated with increased ARDS and multiple organ dysfunction syndrome, in part, because of an effect of etomidate on the inflammatory response.
依托咪酯是一种诱导剂，因其良好的血流动力学特征和快速起效，用于创伤患者的快速顺序插管（RSI）。然而，最近的研究表明依托咪酯会降低循环皮质醇浓度，可能影响炎症反应。我们推测依托咪酯可能会改变受伤患者急性呼吸窘迫综合征（ARDS）的发生率。
我们分析了从一项院前高渗盐水给药临床试验中前瞻性收集的数据。事后，根据患者在院前气道管理中是否接受依托咪酯将患者分组。通过Fisher精确检验比较两组ARDS的发生率。使用逻辑回归来调整其他已知ARDS风险因素的影响。
在2年期间，94例研究患者接受了RSI，其中35例接受了依托咪酯（37%）。两组在人口统计学、生理学、解剖学损伤评分或高渗盐水复苏的使用方面没有显著差异。在调整生理学、损伤严重程度和输血后，使用依托咪酯仍与ARDS相关（调整后比值比 = 3.9，95%置信区间 = 1.24 - 12.0）。
严重受伤创伤患者RSI使用单剂量依托咪酯与ARDS和多器官功能障碍综合征增加相关，部分原因是依托咪酯对炎症反应的影响。
