Airway/systematic review snapshotIs Single-Dose Etomidate Induction Safe in Emergency Intubation of Critically Ill Patients?
Section snippets
Results
OR, Odds ratio; SOFA, Sequential Organ Failure Assessment score.Outcome Studies, Number of Patients Relative Effect (95% CI) Heterogeneity (I²), % Mortality 6 studies, 772 patients OR 1.17 (0.86 to 1.6) 0 Duration of mechanical ventilation, days 3 studies, 621 patients Avg duration: 1.5–13 days; etomidate effect 2.14 days (–1.67 to 5.95 days) 86 Organ dysfunction (SOFA scores) 1 study, 469 patients Mean SOFA score: 9.6; etomidate effect 0.7 (0.01 to 1.39)
Of 1,395 potential titles screened, 8 studies were
Commentary
Etomidate has been a controversial induction agent in emergency intubation for a number of years because of concerns about adrenal suppression and subsequent adverse outcomes.1, 2 The concern about etomidate safety in septic patients was first raised in an observational substudy of the Corticosteroid Therapy of Septic Shock trial.3 The specific flaws of this study are elaborated elsewhere,4 revealing multiple confounding factors and reporting omissions that preclude the erroneous conclusion
References (7)
- et al.
Continue to use etomidate for intubation of patients with septic shock
Ann Emerg Med
(2008) - et al.
In patients with severe sepsis, does a single dose of etomidate to facilitate intubation increase mortality?
Ann Emerg Med
(2013) Etomidate: not worth the risk in septic patients
Ann Emerg Med
(2008)
Cited by (2)
Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review
2021, British Journal of AnaesthesiaCitation Excerpt :Nevertheless, many anaesthesiologists look to alternative induction agents, notably etomidate66 or ketamine,67 for compromised patients or in emergencies. Etomidate depresses adrenocortical function, even when used in single doses, and argument persists regarding the possible adverse consequences for patients.68–70 This anxiety comes in addition to the propensity of etomidate to extraneous muscle movements and PONV.
Thiopental to desflurane-an anaesthetic journey. Where are we going next?
2017, British Journal of AnaesthesiaCitation Excerpt :Etomidate use has greatly declined after concerns about adrenocortical depression and the realisation that most patients can be safely managed with propofol provided it is administered cautiously.46 Recently the potential for etomidate induced harm has been challenged.47–50 The two novel hypnotic compounds have recently been progressed into advanced clinical development, remimazolam51 and ABP-70018 were both targeted in the first instance at sedation for gastrointestinal endoscopy.
Editor’s Note: This is a clinical synopsis, a regular feature of the Annals' Systematic Review Snapshot (SRS) series. The source for this systematic review snapshot is: Bruder EA, Ball IM, Ridi S, et al. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. 2015;(1):CD010225.
Michael Brown, MD, MSc, and Alan Jones, MD, serve as editors of the SRS series.