Outcomes of Etomidate in Severe Sepsis and Septic Shock

Abstract

The discussion over transient adrenal suppression caused by single-dose etomidate has been heated in recent years. The aim of this study was to evaluate the effect of single-dose etomidate in patients with severe sepsis and septic shock. This was a retrospective cohort study conducted in a 56-bed medical/surgical intensive care unit (ICU) at St. John's Mercy Medical Center in St. Louis, Missouri. The study evaluated 224 consecutive patients who had severe sepsis or septic shock and required intubation and mechanical ventilation comparing those patients who had received etomidate to those who had not. Outcome measures were not explicitly defined, but data recorded included Acute Physiology and Chronic Health Evaluation (APACHE) II and Mortality Probability Model at zero hour (MPM-II0) scores, vasopressor and corticosteroid use within 72 h of intubation, and testing and diagnosis of adrenal insufficiency within 72 h of intubation. Testing of adrenal insufficiency was at the discretion of the attending physician, as was use of corticosteroids. Of the 224 patients, 113 patients received etomidate for rapid-sequence intubation, and 111 patients did not. There were no significant differences between the groups in terms of baseline APACHE-II scores or MPM-II0 scores. There were also no significant differences in any of the number of patients receiving testing for adrenal insufficiency (58% in the etomidate group, 52% in the second group), diagnosis of adrenal insufficiency (24% vs. 22%), ICU length of stay, number of ventilator days, or sources of sepsis. The number of patients in the etomidate group who received corticosteroids was significantly higher than in those who did not (42% vs. 22%, p=0.003). Among patients who received etomidate, the relative risk for mortality was 0.92 (confidence interval [CI] 0.74–1.14). The relative risk for vasopressor use in this group was 1.16 (CI 0.9–1.51). Overall, no differences were found in regard to vasopressor use, mortality, or other markers such as ICU days or ventilator days. However, the authors note that due to the increased steroid use in the etomidate group, this information is difficult to interpret.