title: Effects of etomidate on vasopressor use in patients with sepsis or severe sepsis: a propensity-matched analysis.
abstract: OBJECTIVE
  The safety of single-bolus etomidate to facilitate intubation in septic patients is controversial due to its potential to suppress adrenal steroidogenesis. The purpose of this study was to evaluate the effects of etomidate on the development of shock when used as an induction agent to facilitate intubation in septic patients.
  
  
  METHODS
  A multicenter, retrospective, propensity-matched cohort study comparing patients with sepsis or severe sepsis who either received etomidate or did not receive etomidate for intubation was conducted. The primary outcome was the difference in the need for vasopressor support within 72 hours after intubation. Secondary outcomes included the use of multiple vasopressors, intensive care unit length of stay, and in-hospital mortality.
  
  
  RESULTS
  A total of 411 patients were analyzed. Eighty-three patients were matched by propensity score. There was no difference in the matched cohort in regards to vasopressor use within 72 hours of intubation (odds ratio, 0.95; 95% confidence interval, 0.52-1.76; P=.88). Furthermore, there were no significant differences observed with regard to secondary outcomes, including in-hospital mortality (P=.76).
  
  
  CONCLUSIONS
  The use of etomidate for intubation in septic patients did not increase vasopressor requirements within 72 hours after intubation.
authors.affiliation: Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH 43205.
authors.forename: Nerissa J
authors.initials: NJ
authors.lastname: Alday
authors.affiliation: Methodist University Hospital, University of Tennessee College of Pharmacy, Memphis, TN 38104.
authors.forename: G Morgan
authors.initials: GM
authors.lastname: Jones
authors.affiliation: Methodist University Hospital, University of Tennessee College of Pharmacy, Memphis, TN 38104.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Kimmons
authors.affiliation: Center for Biostatistics, Ohio State University, Columbus, OH 43221.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Phillips
authors.affiliation: Department of Internal Medicine, Wexner Medical Center at Ohio State University, Columbus, OH 43221; Pulmonary, Allergy, Critical Care and Sleep Medicine, Davis Heart and Lung Research Institute, Columbus, OH 43210-1267.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: McCallister
authors.affiliation: Department of Pharmacy, Wexner Medical Center at Ohio State University, Columbus, OH 43210-1228. Electronic address: Bruce.Doepker@osumc.edu.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Doepker
mesh_terms: D000311:Adrenal Glands / Q000187:drug effects / Q000378:metabolism; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D016022:Case-Control Studies; D015331:Cohort Studies; D005045:Etomidate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D018686:Anesthetics, Intravenous; D014662:Vasoconstrictor Agents; D005045:Etomidate
keywords: Adrenal insufficiency; Etomidate; Hypotension; Sepsis; Vasopressor