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      Effects of Etomidate on Postintubation Hypotension, Inflammatory Markers, and Mortality in Critically Ill Patients with COVID-19: An International, Multicenter, Retrospective Study

      research-article
      Author(s): , MD 1 , , MD 1 , , MD 1 , , MD, PhD 2 , , MD 3 , , MD 1 , , MD 1 , , MD 1 , , MD 4 , , MD 3 , , MD 3 , , MD, PhD 3 , , MD 5 , , MD, PhD 6 , , MD, PhD 7 , , MD, PhD 4 , , MD 1 , , MD, PhD 8 , 9 , , ETOCOVID Study group
      Publication date (Electronic):
      Journal: Journal of Intensive Care Medicine
      Publisher: SAGE Publications
      Keywords: COVID-19, critical care, etomidate, postintubation hypotension, outcome

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          Abstract

          Objective

          To evaluate the association of etomidate with postintubation hypotension, inflammation, and mortality in critically ill patients with COVID-19.

          Design

          International, multicenter, retrospective study.

          Participants

          Critically ill patients hospitalized specifically for COVID-19 from three major academic institutions in the US and Europe.

          Main Outcome and Measures

          Patients were allocated into the etomidate (ET) group or another induction agent (OA) group. The primary outcome was postintubation hypotension. Secondary outcomes included postintubation inflammatory status, in-hospital mortality, and mortality at 30 days.

          Results

          171 patients with a median age of 68 (IQR 58-73) years were included (ET, n  =  98; OA, n  =  73). Etomidate was associated with lower postintubation mean arterial pressure [74.33 (64-85) mm Hg versus 81.84 (69.75–94.25) mm Hg, p  =  0.005] compared to other agents. No statistically significant differences were generally observed in inflammatory markers between the two groups at 7- and 14-days after admission to the intensive care unit. In-hospital mortality [77 (79%) versus 41 (56%), p  =  0.003] and mortality at 30-days [78 (80%) versus 43 (59%), p  =  0.006] were higher in the ET group. In multivariate logistic regression analysis, only etomidate (p  =  0.009) and postintubation mean arterial pressure (p < 0.001) had a statistically significant effect on mortality, in contrast to stress-dose steroids (p  =  0.301), after adjusting for creatinine (p  =  0.695), blood urea nitrogen (p  =  0.153), age (p  =  0.055), oxygen saturation of hemoglobin (SpO 2) (p  =  0.941), and fraction of inspired oxygen (FiO 2) (p  =  0.712).

          Conclusions

          Administration of a single-bolus dose of etomidate in critically ill patients with COVID-19 is associated with lower postintubation mean arterial pressure and higher in-hospital and 30-day mortality compared to other induction agents.

          Abstract

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          Most cited references33

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          Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

          Waleed Alhazzani, Morten Hylander Møller, Yaseen M. Arabi … (2020)
          Background The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. Methods We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. Results The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy. Conclusion The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new recommendations in further releases of these guidelines. Electronic supplementary material The online version of this article (10.1007/s00134-020-06022-5) contains supplementary material, which is available to authorized users.
          Article 0 comments Cited 894 times – based on 0 reviews     Review now
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            Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update

            Waleed Alhazzani, Laura A. Evans, Fayez Alshamsi … (2021)
            The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU.
            Article 0 comments Cited 184 times – based on 0 reviews     Review now
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              Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries

              Vincenzo Russotto, Sheila Nainan Myatra (2021)
              Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events.
              Article 0 comments Cited 107 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Intensive Care Med
                Journal ID (iso-abbrev): J Intensive Care Med
                Journal ID (publisher-id): JIC
                Journal ID (hwp): spjic
                Title: Journal of Intensive Care Medicine
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 0885-0666
                ISSN (Electronic): 1525-1489
                Publication date (Electronic): 7 May 2023
                Publication date PMC-release: 7 May 2023
                Electronic Location Identifier: 08850666231173847
                Affiliations
                [1 ]Department of Critical Care Medicine, Ringgold 6473, universitySt. Joseph's University Medical Center; , Paterson, NJ, USA
                [2 ]First Department of Neurology, Eginition University Hospital, Medical School, Ringgold 68993, universityNational and Kapodistrian University of Athens; , Athens, Greece
                [3 ]Intensive Care Unit, Hospital Universitario Santa Lucía, Cartagena, Spain
                [4 ]Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, Larisa, Greece
                [5 ]Department of Emergency Medicine, Tzaneio General Hospital, Piraeus, Greece
                [6 ]Department of Anesthesiology, Agia Sophia Children's Hospital, Athens, Greece
                [7 ]Department of Laboratory Medicine, Hospital Universitario Santa Lucía, Cartagena, Spain
                [8 ]Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
                [9 ]Outcomes Research Consortium, Cleveland, OH, USA
                Author notes
                [†]

                Authors contributed equally and share authorship

                [#]

                Authors contributed equally and share authorship

                [¥]

                Authors contributed equally and share authorship

                [£]

                Authors contributed equally and share authorship

                [*]Athanasios Chalkias MD, MSc, PhD, FESC, FAcadTM, FCP, FESAIC, Department of Anesthesiology, University Hospital of Larisa, 41110 Biopolis, Larisa, Greece. Email: thanoschalkias@ 123456yahoo.gr
                Author information
                https://orcid.org/0000-0002-7634-4665
                Article
                Publisher ID: 10.1177_08850666231173847
                DOI: 10.1177/08850666231173847
                PMC ID: 10170262
                PubMed ID: 37151026
                SO-VID: 880daf44-5527-4b79-a1bc-9c6d14f7904f
                Copyright © © The Author(s) 2023
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 19 November 2022
                Date revision received : 17 April 2023
                Date accepted : 19 April 2023
                Categories
                Subject: Original Research
                Custom metadata
                edited-state corrected-proof
                typesetter ts19

                Keywords: covid-19,critical care,etomidate,postintubation hypotension,outcome
                Data availability:
                Keywords: covid-19, critical care, etomidate, postintubation hypotension, outcome

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