Etomidate increases susceptibility to pneumonia in trauma patients.
OBJECTIVE
To investigate the impact of etomidate on the rate of hospital-acquired pneumonia (HAP) in trauma patients and the effects of hydrocortisone in etomidate-treated patients.


METHODS
This was a sub-study of the HYPOLYTE multi-centre, randomized, double-blind, placebo-controlled trial of hydrocortisone in trauma patients (NCT00563303). Inclusion criterion was trauma patient with mechanical ventilation (MV) of ≥48 h. The use of etomidate was prospectively collected. Endpoints were the results of the cosyntropin test and rate of HAP on day 28 of follow-up.


RESULTS
Of the 149 patients enrolled in the study, 95 (64 %) received etomidate within 36 h prior to inclusion. 79 (83 %) of 95 patients receiving etomidate and 34 of the 54 (63 %) not receiving etomidate had corticosteroid insufficiency (p = 0.006). The administration of etomidate did not alter basal cortisolemia (p = 0.73), but it did decrease the delta of cortisolemia at 60 min (p = 0.007). There was a correlation between time from etomidate injection to inclusion in the study and sensitivity to corticotropin (R (2) = 0.19; p = 0.001). Forty-nine (51.6 %) patients with etomidate and 16 (29.6 %) patients without etomidate developed HAP by day 28 (p = 0.009). Etomidate was associated with HAP on day 28 in the multivariate analysis (hazard ratio 2.48; 95 % confidence interval 1.19-5.18; p = 0.016). Duration of MV with or without etomidate was not significantly different (p = 0.278). Among etomidate-exposed patients, 18 (40 %) treated with hydrocortisone developed HAP compared with 31 (62 %) treated with placebo (p = 0.032). Etomidate-exposed patients treated with hydrocortisone had fewer ventilator days (p < 0.001).


CONCLUSIONS
Among the patients enrolled in the study, etomidate did not alter basal cortisolemia, but it did decrease reactivity to corticotropin. We suggest that in trauma patients, etomidate is an independent risk factor for HAP and that the administration of hydrocortisone should be considered after etomidate use.
Intensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu-HME, University Hospital of Nantes, Nantes, France. karim.asehnoune@chu-nantes.fr
Karim
K
Asehnoune
Pierre Joachim
PJ
Mahe
Philippe
P
Seguin
Samir
S
Jaber
Boris
B
Jung
Christophe
C
Guitton
Nolwen
N
Chatel-Josse
Aurelie
A
Subileau
Anne Charlotte
AC
Tellier
Françoise
F
Masson
Benoit
B
Renard
Yannick
Y
Malledant
Corinne
C
Lejus
Christelle
C
Volteau
Véronique
V
Sébille
Antoine
A
Roquilly
D000293:Adolescent; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003366:Cosyntropin; D003428:Cross Infection / Q000139:chemically induced* / Q000188:drug therapy; D004311:Double-Blind Method; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000139:chemically induced* / Q000188:drug therapy; D012121:Respiration, Artificial; D012307:Risk Factors; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
D018686:Anesthetics, Intravenous; D003366:Cosyntropin; D006854:Hydrocortisone; D005045:Etomidate