Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury.
BACKGROUND
Etomidate is an induction agent used for the rapid sequence intubation (RSI) of trauma patients because of its favorable hemodynamic profile and rapid onset. However, recent studies have shown etomidate to decrease circulating cortisol concentrations, potentially influencing inflammation. We hypothesized that etomidate may alter the occurrence of acute respiratory distress syndrome (ARDS) in injury victims.


METHODS
We analyzed data collected prospectively from a clinical trial of prehospital hypertonic saline administration. Post hoc, patients were grouped according to whether they did or did not receive etomidate for prehospital airway management. The incidence of ARDS was compared between the two groups by Fisher's exact test. Logistic regression was used to adjust for the effects of other known risk factors for ARDS.


RESULTS
Over a 2-year period, 94 study patients underwent RSI, of which 35 received etomidate (37%). There were no significant differences in demographic, physiology, anatomic injury scores, or use of hypertonic saline resuscitation between the groups. After adjusting for physiology, injury severity, and transfusion, etomidate use remained associated with ARDS (aOR = 3.9, 95% CI =1.24-12.0).


CONCLUSIONS
Single-dose etomidate for RSI in severely injured trauma patients is associated with increased ARDS and multiple organ dysfunction syndrome, in part, because of an effect of etomidate on the inflammatory response.
Warner
Keir J
KJ
Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA. keirw@u.washington.edu
Cuschieri
Joseph
J
Jurkovich
Gregory J
GJ
Bulger
Eileen M
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D015599:Trauma Severity Indices; D014861:Washington / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
D006993:Hypnotics and Sedatives; D005045:Etomidate