Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis

Boris Jung, Noemie Clavieras, Stephanie Nougaret, Nicolas Molinari, Antoine Roquilly, Moussa Cisse, Julie Carr, Gerald Chanques, Karim Asehnoune, Samir Jaber, Boris Jung, Noemie Clavieras, Stephanie Nougaret, Nicolas Molinari, Antoine Roquilly, Moussa Cisse, Julie Carr, Gerald Chanques, Karim Asehnoune, Samir Jaber

Abstract

Introduction: Endotracheal intubation in the ICU is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock cases in our ICU, may counteract some negative effects of etomidate.

Methods: A single-center observational study was carried out in septic shock patients, treated with hydrocortisone and intubated within the first 48 hours of septic shock. Co-primary end points were life-threatening complications incidence occurring within the first hour after intubation and mortality during the ICU stay. Statistical analyses included unmatched and matched cohorts using a propensity score analysis. P < 0.05 was considered significant.

Results: Sixty patients in the etomidate cohort and 42 patients in the non-etomidate cohort were included. Critical illness-related corticosteroid insufficiency was 79% in the etomidate cohort and 52% in the non-etomidate cohort (P = 0.01). After intubation, life-threatening complications occurred in 36% of the patients whatever the cohort. After adjustment with propensity score analysis, etomidate was a protective factor for death in the ICU both in unmatched (hazard ratio, 0.33 (0.15 to 0.75); P < 0.01)) and matched cohorts (hazard ratio, 0.33 (0.112 to 0.988); P = 0.04).

Conclusion: In septic shock patients treated with hydrocortisone, etomidate did not decrease life-threatening complications following intubation, but when associated with hydrocortisone it also did not impair outcome.

Figures

Figure 1
Figure 1
Incidence of life-threatening complications according to the hypnotic used to facilitate intubation. No difference in life threatening complications rates was found between the hypnotic used. NS, not significant.
Figure 2
Figure 2
Kaplan-Meier curves comparing survival probability after propensity score adjustment in etomidate and non-etomidate cohorts. Etomidate was associated with a significant lower risk of mortality at day 28. HR, hazard ratio.

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