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

Boris Jung1, Noemie Clavieras1, Stephanie Nougaret2, Nicolas Molinari3, Antoine Roquilly4, Moussa Cisse1, Julie Carr1, Gerald Chanques1, Karim Asehnoune4 and Samir Jaber1*

Author Affiliations

1 Intensive Care Unit, Department of Anaesthesia and Critical Care, Saint Eloi Teaching Hospital and Institut National de la Santé et de la Recherche Médicale Unit 1046 (INSERM U-1046), Montpellier 1 University, 80 avenue Augustin Fliche, F-34295 Montpellier, Cedex 5, France

2 Department of Abdominal Imaging, Saint Eloi Teaching Hospital, Montpellier 1 University, 80 avenue Augustin Fliche, F-34295 Montpellier, Cedex 5, France

3 Department of Medical Statistics, Arnaud de Villeneuve Teaching Hospital, Montpellier 1 University, 80 avenue Augustin Fliche, F-34295 Montpellier, Cedex 5, France

4 Department of Anesthesiology and Intensive Care Medicine, Hôtel Dieu Teaching Hospital, Nantes University, 1 place Alexis-Ricordeau, 44093 Nantes cedex 1, France

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Critical Care 2012, 16:R224  doi:10.1186/cc11871

Published: 21 November 2012

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.

The aim of our study was to compare septic shock patients who received etomidate versus another induction drug both for short-term safety and for long-term outcomes.

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.