From the, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
the, Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Acad Emerg Med. 2020 Nov;27(11):1140-1149. doi: 10.1111/acem.14070. Epub 2020 Jul 20.
The objectives of this study were 1) to describe the current use of etomidate and other induction agents in patients with sepsis and 2) to compare adverse events between etomidate and ketamine in sepsis.
This was an observational cohort study of the prospective National Emergency Airway Registry (NEAR) data set. Descriptive statistics were used to report the distribution of induction agents used in patients with sepsis. Adverse events were compared using bivariate analysis, and a sensitivity analysis was conducted using a propensity score-adjusted analysis of etomidate versus ketamine.
A total of 531 patients were intubated for sepsis, and the majority (71%) were intubated with etomidate as the initial induction agent. Etomidate was less frequently used in sepsis patients than nonsepsis patients (71% vs. 85%, odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.4 to 0.5). Sepsis patients had a greater risk of adverse events, and vasopressor therapy was required for 25% of patients after intubation. Postprocedure hypotension was higher between those intubated for sepsis with ketamine versus etomidate (74% vs. 50%, OR = 2.9, 95% CI = 1.9 to 4.5). After confounding by indication in the propensity score-adjusted analysis was accounted for, ketamine was associated with more postprocedure hypotension (OR = 2.7, 95% CI = 1.1 to 6.7). No difference in emergency department deaths was observed.
Etomidate is used less frequently in sepsis patients than nonsepsis patients, with ketamine being the most frequently used alternative. Ketamine was associated with more postprocedural hypotension than etomidate. Future clinical trials are needed to determine the optimal induction agent in patients with sepsis.
本研究的目的是 1）描述脓毒症患者中依托咪酯和其他诱导剂的当前使用情况，2）比较脓毒症中依托咪酯和氯胺酮的不良事件。
这是对前瞻性国家紧急气道登记（NEAR）数据集的观察性队列研究。使用描述性统计来报告脓毒症患者中使用的诱导剂分布。使用双变量分析比较不良事件，并使用倾向评分调整的依托咪酯与氯胺酮分析进行敏感性分析。
共有 531 例患者因脓毒症行气管插管，其中大多数（71%）以依托咪酯作为初始诱导剂。脓毒症患者中依托咪酯的使用频率低于非脓毒症患者（71% vs. 85%，优势比[OR] = 0.4，95%置信区间[CI] = 0.4 至 0.5）。脓毒症患者发生不良事件的风险更高，插管后 25%的患者需要血管加压药治疗。与依托咪酯相比，脓毒症患者使用氯胺酮后出现术后低血压的比例更高（74% vs. 50%，OR = 2.9，95%CI = 1.9 至 4.5）。在倾向评分调整分析中排除混杂因素后，氯胺酮与更多的术后低血压相关（OR = 2.7，95%CI = 1.1 至 6.7）。未观察到急诊科死亡的差异。
脓毒症患者中依托咪酯的使用频率低于非脓毒症患者，而氯胺酮是最常用的替代药物。与依托咪酯相比，氯胺酮与更多的术后低血压相关。需要进一步的临床试验来确定脓毒症患者的最佳诱导剂。
