依托咪酯在严重脓毒症和脓毒性休克中的结局。

Outcomes of etomidate in severe sepsis and septic shock.

机构信息

Division of Pulmonary, Critical Care, and Sleep Medicine, Saint Louis University Hospital, Louis, MO 63104, USA.

出版信息

Chest. 2010 Dec;138(6):1327-32. doi: 10.1378/chest.10-0790. Epub 2010 Jul 22.

DOI:10.1378/chest.10-0790

PMID:20651024

Abstract

BACKGROUND

The use of single-dose etomidate to facilitate intubation in critically ill patients has recently been debated given its suppression of steroidogenesis with possible resultant adverse outcomes. Our objective was to assess the effects of single-dose etomidate used during rapid-sequence intubation (RSI) on various measures of outcome, such as mortality, vasopressor use, corticosteroid use, ICU length of stay (ICU-LOS), and number of ventilator days.

METHODS

A retrospective 18-month cohort study was performed in a multidisciplinary ICU of an academic tertiary care institution. Consecutive patients with severe sepsis or septic shock who were intubated and mechanically ventilated were identified and grouped as having received single-dose etomidate during intubation or not. Hospital mortality, ICU length of stay, number of ventilator days, corticosteroid use, vasopressor use, and demographic and clinical variables were recorded.

RESULTS

Two hundred twenty-four patients were identified; 113 had received etomidate. The mean Acute Physiology and Chronic Health Evaluation II scores in the etomidate and nonetomidate groups were 21.3 ± 8.1 and 21.9 ± 8.3, respectively (P = .62). The relative risks for mortality and vasopressor use were 0.92 (CI, 0.74-1.14; P = 0.51) and 1.16 (CI, 0.9-1.51; P = .31), respectively, in the etomidate group. There were no significant differences in ICU-LOS (mean, 14 vs 12 days; P = .31) or number of ventilator days (mean, 11 vs 8 days; P = .13) between the etomidate and nonetomidate groups, respectively. The relative risk for corticosteroid use in the etomidate group was 1.34 (CI, 1.11-1.61; P = .003). Multivariate analysis using logistic regression demonstrated no significant association of etomidate with mortality (OR, 0.9; CI, 0.45-1.83; P = .78).

CONCLUSION

Single-dose etomidate used during RSI in critically ill patients with severe sepsis and septic shock was not associated with increased mortality, vasopressor use, ICU-LOS, or number of ventilator days. Patients intubated with etomidate had an increased incidence of subsequent corticosteroid use, with no difference in outcomes.

摘要

背景

由于依托咪酯会抑制类固醇的生成，可能导致不良后果，因此最近对于在危重症患者中单次使用依托咪酯以促进插管这一做法存在争议。我们的目的是评估在快速序贯诱导插管（RSI）期间使用单次剂量依托咪酯对死亡率、血管加压药使用、皮质类固醇使用、重症监护病房（ICU）住院时间（ICU-LOS）和呼吸机使用天数等各种转归指标的影响。

方法

这是一项在学术性三级护理机构的多学科 ICU 中进行的为期 18 个月的回顾性队列研究。连续纳入因严重脓毒症或感染性休克而插管和机械通气的患者，并将其分为接受插管时单次使用依托咪酯的组和未使用依托咪酯的组。记录医院死亡率、ICU 住院时间、呼吸机使用天数、皮质类固醇使用、血管加压药使用以及人口统计学和临床变量。

结果

共确定了 224 例患者，其中 113 例使用了依托咪酯。依托咪酯组和非依托咪酯组的急性生理学和慢性健康评估 II 评分分别为 21.3±8.1 和 21.9±8.3（P=0.62）。依托咪酯组的死亡率和血管加压药使用率的相对风险分别为 0.92（95%CI，0.74-1.14；P=0.51）和 1.16（95%CI，0.9-1.51；P=0.31）。依托咪酯组和非依托咪酯组的 ICU 住院时间（分别为 14 天 vs 12 天；P=0.31）和呼吸机使用天数（分别为 11 天 vs 8 天；P=0.13）无显著差异。依托咪酯组皮质类固醇使用率的相对风险为 1.34（95%CI，1.11-1.61；P=0.003）。使用逻辑回归进行多变量分析显示，依托咪酯与死亡率无显著关联（OR，0.9；95%CI，0.45-1.83；P=0.78）。