Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
Ann Emerg Med. 2010 Nov;56(5):481-9. doi: 10.1016/j.annemergmed.2010.05.034. Epub 2010 Sep 15.
Etomidate, a widely used induction agent for rapid sequence intubation in the emergency department (ED), causes measurable adrenal suppression after a single bolus dose. The clinical significance of this adrenal suppression in patients with sepsis remains controversial. We seek to determine the difference in hospital length of stay between patients with suspected sepsis who receive either etomidate or midazolam during intubation in our ED.
We performed a prospective, double-blind, randomized study of patients with suspected sepsis who were intubated in our ED during an 18-month period. Eligible patients who were critically ill and were suspected of having sepsis were randomized to receive either etomidate or midazolam before intubation.
A total of 122 patients were enrolled; 59 received midazolam and 63 received etomidate. Two patients in the etomidate group were lost to follow-up. Patient baseline characteristics were similar between groups. There were no significant differences in median hospital length of stay (9.5 versus 7.3 days), ICU length of stay (4.2 versus 3.1 days), or ventilator days (2.8 versus 2.1) between patients who received midazolam and those who received etomidate, respectively. Inhospital mortality was 21 of 59 (36%; 95% confidence interval 24% to 49%) for patients who received midazolam and 26 of 61 (43%; 95% confidence interval 30% to 56%) for patients who received etomidate. For patients who survived to hospital discharge, the median length of stay was 11.3 days in the midazolam group versus 11.8 days in the etomidate group; for patients who died, the median length of stay was 2.9 days in the midazolam group versus 3.3 days in the etomidate group.
Patients with suspected sepsis and who received a single bolus dose of etomidate for rapid sequence intubation showed no significant increase in hospital length of stay compared with patients who received a single bolus dose of midazolam.
依托咪酯是急诊科（ED）中快速序贯插管中广泛使用的诱导剂，单次推注后可导致可测量的肾上腺抑制。这种肾上腺抑制在脓毒症患者中的临床意义仍存在争议。我们旨在确定在我们的 ED 中接受插管时接受依托咪酯或咪达唑仑的疑似脓毒症患者的住院时间长短是否存在差异。
我们对在 18 个月期间在我们的 ED 中接受插管的疑似脓毒症患者进行了一项前瞻性、双盲、随机研究。纳入的危重症且疑似患有脓毒症的合格患者被随机分为插管前接受依托咪酯或咪达唑仑。
共有 122 名患者入组；59 名患者接受咪达唑仑，63 名患者接受依托咪酯。依托咪酯组有 2 名患者失访。两组患者的基线特征相似。接受咪达唑仑和依托咪酯的患者的中位住院时间（9.5 天 vs. 7.3 天）、ICU 住院时间（4.2 天 vs. 3.1 天）和呼吸机天数（2.8 天 vs. 2.1 天）均无显著差异。接受咪达唑仑的患者的院内死亡率为 59 例中的 21 例（36%；95%置信区间 24%至 49%），接受依托咪酯的患者的死亡率为 61 例中的 26 例（43%；95%置信区间 30%至 56%）。对于存活至出院的患者，咪达唑仑组的中位住院时间为 11.3 天，依托咪酯组为 11.8 天；对于死亡患者，咪达唑仑组的中位住院时间为 2.9 天，依托咪酯组为 3.3 天。
接受依托咪酯单次推注用于快速序贯插管的疑似脓毒症患者与接受咪达唑仑单次推注的患者相比，住院时间无显著延长。
