title: Risk factors for mortality in septic patients who received etomidate.
abstract: OBJECTIVE
  To characterize risk factors for mortality in septic patients who received etomidate for rapid sequence intubation.
  
  
  METHODS
  This study was a retrospective cohort conducted at a large, tertiary, urban, academic medical center that included patients with severe sepsis or septic shock who received etomidate between January 1, 2010, and December 31, 2012.
  
  
  RESULTS
  A total of 169 patients were included with similar baseline characteristics. There were more men in the nonsurvivor group than in the survivor group (67.1% vs 50.6%, P=.03). Septic shock occurred in 91.5% of nonsurvivors and 69% of survivors (P<.01). Nonsurvivors also had a higher initial lactate of (5.1±4.3 mmol/L vs 3.6±3.4 mmol/L, P=.02) and more vasopressor therapy (91.5% vs 69%, P<.01), required a higher number of vasopressors (2.2±1.1 vs 1.3±1, P<.01), and were administered hydrocortisone (53.7% vs 34.5%, P=.01). Abdominal source of sepsis (P=.048) and number of vasopressors (P=.01) were predictive of 30-day mortality.
  
  
  CONCLUSIONS
  An alternative sedative induction agent may be considered for use in rapid sequence intubation in patients on multiple vasopressors or with abdominal source of infection.
authors: Department of Pharmacy, Loyola University Medical Center, Maywood, IL; Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL. Electronic address: mrech@lumc.edu.
authors: Megan A
authors: MA
authors: Rech
authors: Department of Pharmacy, Loyola University Medical Center, Maywood, IL.
authors: Stephanie
authors: S
authors: Bennett
authors: Department of Pharmacy, Loyola University Medical Center, Maywood, IL.
authors: Whitney
authors: W
authors: Chaney
authors: Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL.
authors: Ethan
authors: E
authors: Sterk
mesh_terms: D018806:APACHE; D018784:Abdominal Abscess / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000401:mortality; D000704:Analysis of Variance; D002641:Chicago / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007440:Intubation / Q000379:methods / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D006993:Hypnotics and Sedatives; D014662:Vasoconstrictor Agents; D005045:Etomidate