Etomidate increases susceptibility to pneumonia in trauma patients
Intensive Care Medicine, 07/17/2012
Asehnoune K et al. – The authors suggest that in trauma patients, etomidate is an independent risk factor for hospital–acquired pneumonia (HAP) and that the administration of hydrocortisone should be considered after etomidate use.Methods
- This was a sub–study of the HYPOLYTE multi–centre, randomized, double–blind, placebo–controlled trial of hydrocortisone in trauma patients.
- Inclusion criterion was trauma patient with mechanical ventilation (MV) of ≥48h.
- 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.
- Of the 149 patients enrolled in the study, 95 (64 %) received etomidate within 36h 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 60min (p=0.007).
- There was a correlation between time from etomidate injection to inclusion in the study and sensitivity to corticotropin (R2=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).