title: Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Noemie
authors.initials: N
authors.lastname: Clavieras
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nougaret
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.forename: Moussa
authors.initials: M
authors.lastname: Cisse
authors.forename: Julie
authors.initials: J
authors.lastname: Carr
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000368:Aged; D005045:Etomidate / Q000009:adverse effects* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy
chemical_list: D006993:Hypnotics and Sedatives; D006854:Hydrocortisone; D005045:Etomidate