Gu Wan-Jie, Wang Fei, Tang Lu, Liu Jing-Chen
Department of Anaesthesiology, First Affiliated Hospital of Guangxi Medical University, Nanning.
Department of Anaesthesiology, General Hospital of Jinan Military Command, Jinan, China.
Chest. 2015 Feb;147(2):335-346. doi: 10.1378/chest.14-1012.
The effect of single-dose etomidate on mortality in patients with sepsis remains controversial. We systematically reviewed the literature to investigate whether a single dose of etomidate for rapid sequence intubation increased mortality in patients with sepsis.
PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and observational studies regarding the effect of single-dose etomidate on mortality in adults with sepsis. The primary outcome was all-cause mortality. The Mantel-Haenszel method with random-effects modeling was used to calculate pooled relative risks (RRs) and 95% CIs.
Eighteen studies (two RCTs and 16 observational studies) in 5,552 patients were included. Pooled analysis suggested that single-dose etomidate was not associated with increased mortality in patients with sepsis in both the RCTs (RR, 1.20; 95% CI, 0.84-1.72; P = .31; I(2) = 0%) and the observational studies (RR, 1.05; 95% CI, 0.97-1.13; P = .23; I(2) = 25%). When only adjusted RRs were pooled in five observational studies, RR for mortality was 1.05 (95% CI, 0.79-1.39; P = .748; I(2) = 71.3%). These findings also were consistent across all subgroup analyses for observational studies. Single-dose etomidate increased the risk of adrenal insufficiency in patients with sepsis (eight studies; RR, 1.42; 95% CI, 1.22-1.64; P < .00001).
Current evidence indicates that single-dose etomidate does not increase mortality in patients with sepsis. However, this finding largely relies on data from observational studies and is potentially subject to selection bias; hence, high-quality and adequately powered RCTs are warranted.
单剂量依托咪酯对脓毒症患者死亡率的影响仍存在争议。我们系统回顾了文献，以调查单剂量依托咪酯用于快速顺序诱导插管是否会增加脓毒症患者的死亡率。
检索PubMed、Embase和CENTRAL（Cochrane对照试验中央注册库），查找关于单剂量依托咪酯对成年脓毒症患者死亡率影响的随机对照试验（RCT）和观察性研究。主要结局为全因死亡率。采用随机效应模型的Mantel-Haenszel方法计算合并相对风险（RR）和95%置信区间（CI）。
纳入了18项研究（2项RCT和16项观察性研究），共5552例患者。合并分析表明，在RCT（RR，1.20；95%CI，0.84-1.72；P = 0.31；I² = 0%）和观察性研究（RR，1.05；95%CI，0.97-1.13；P = 0.23；I² = 25%）中，单剂量依托咪酯均与脓毒症患者死亡率增加无关。在5项观察性研究中仅汇总调整后的RR时，死亡率的RR为1.05（95%CI，0.79-1.39；P = 0.748；I² = 71.3%）。这些结果在观察性研究的所有亚组分析中也一致。单剂量依托咪酯增加了脓毒症患者肾上腺功能不全的风险（8项研究；RR，1.42；95%CI，1.22-1.64；P < 0.00001）。
目前的证据表明，单剂量依托咪酯不会增加脓毒症患者的死亡率。然而，这一发现很大程度上依赖于观察性研究的数据，可能存在选择偏倚；因此，需要高质量且有足够样本量的RCT。
