Department of Anesthesiology, Weill Cornell Medicine, New York, New York.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
Am J Respir Crit Care Med. 2024 Nov 15;210(10):1243-1251. doi: 10.1164/rccm.202404-0813OC.
Uncertainty remains regarding the risks associated with single-dose use of etomidate. To assess the use of etomidate in critically ill patients and compare outcomes for patients who received etomidate versus ketamine. We assessed patients who received invasive mechanical ventilation (IMV) and were admitted to an ICU in the Premier Healthcare Database between 2008 and 2021. The exposure was receipt of etomidate on the day of IMV initiation, and the main outcome was hospital mortality. Using multivariable regression, we compared patients who received IMV within the first 2 days of hospitalization who received etomidate with propensity score-matched patients who received ketamine. We also assessed whether receipt of corticosteroids in the days after intubation modified the association between etomidate and mortality. Of 1,689,945 patients who received IMV, nearly half (738,855; 43.7%) received etomidate. Among those who received IMV in the first 2 days of hospitalization, we established 22,273 matched pairs administered either etomidate or ketamine. In the primary analysis, receipt of etomidate was associated with greater hospital mortality relative to ketamine (21.6% vs. 18.7%; absolute risk difference, 2.8%; 95% confidence interval, 2.1%, 3.6%; adjusted odds ratio, 1.28, 95% confidence interval, 1.21,1.34). This was consistent across subgroups and sensitivity analyses. We found no attenuation of the association with mortality with receipt of corticosteroids in the days after etomidate use. Use of etomidate on the day of IMV initiation is common and associated with a higher odds of hospital mortality than use of ketamine. This finding is independent of subsequent treatment with corticosteroids.
关于依托咪酯单次使用相关的风险仍存在不确定性。为评估依托咪酯在危重症患者中的应用，并比较接受依托咪酯和氯胺酮的患者的结局。我们评估了 2008 年至 2021 年期间在 Premier Healthcare Database 中接受有创机械通气（IMV）并入住 ICU 的患者。暴露因素为 IMV 开始当天接受依托咪酯，主要结局为医院死亡率。我们使用多变量回归，比较了在住院的前 2 天内接受 IMV 且接受依托咪酯的患者与接受氯胺酮且经倾向评分匹配的患者。我们还评估了在插管后几天内接受皮质类固醇治疗是否改变了依托咪酯与死亡率之间的关联。在接受 IMV 的 1689945 例患者中，近一半（738855 例；43.7%）接受了依托咪酯。在住院的前 2 天内接受 IMV 的患者中，我们建立了 22273 对接受依托咪酯或氯胺酮治疗的匹配对。在主要分析中，与接受氯胺酮相比，接受依托咪酯与更高的医院死亡率相关（21.6%比 18.7%；绝对风险差异，2.8%；95%置信区间，2.1%，3.6%；调整后的比值比，1.28，95%置信区间，1.21，1.34）。这在亚组和敏感性分析中是一致的。我们没有发现使用依托咪酯后几天内接受皮质类固醇治疗会减弱与死亡率的关联。在 IMV 开始当天使用依托咪酯很常见，与使用氯胺酮相比，其发生医院死亡率的几率更高。这一发现独立于随后使用皮质类固醇治疗。
