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Abstract：
UNASSIGNED: To evaluate the association of etomidate with postintubation hypotension, inflammation, and mortality in critically ill patients with COVID-19.
METHODS: International, multicenter, retrospective study.
METHODS: Critically ill patients hospitalized specifically for COVID-19 from three major academic institutions in the US and Europe.
METHODS: 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 (SpO2) (p = 0.941), and fraction of inspired oxygen (FiO2) (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.
METHODS: International, multicenter, retrospective study.
METHODS: Critically ill patients hospitalized specifically for COVID-19 from three major academic institutions in the US and Europe.
METHODS: 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 (SpO2) (p = 0.941), and fraction of inspired oxygen (FiO2) (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.
摘要：
■为了评估依托咪酯与插管后低血压的关系，炎症,COVID-19危重患者的死亡率。
方法：国际，多中心，回顾性研究。
方法：来自美国和欧洲三大学术机构的因COVID-19而住院的重症患者。
方法：将患者分为依托咪酯（ET）组或其他诱导剂（OA）组。主要结果是插管后低血压。次要结果包括插管后炎症状态，住院死亡率，和30天的死亡率。
结果：纳入171例中位年龄为68（IQR58-73）岁的患者（ET，n=98；OA，n=73）。依托咪酯与插管后平均动脉压较低相关[74.33（64-85）mmHg与81.84（69.75-94.25）mmHg，与其他试剂相比，p=0.005]。在入住重症监护病房后7天和14天，两组之间的炎症标志物通常没有观察到统计学上的显着差异。住院死亡率[77（79%）对41（56%），p=0.003]和30天死亡率[78（80%）对43（59%），p=0.006]在ET组中较高。在多变量逻辑回归分析中，只有依托咪酯(p=0.009)和插管后平均动脉压(p<0.001)对死亡率有统计学意义的影响,与应激剂量类固醇相反（p=0.301），校正肌酐后（p=0.695），血尿素氮（p=0.153），年龄（p=0.055），血红蛋白氧饱和度（SpO2）（p=0.941），和吸入氧的分数(FiO2)(p=0.712)。
结论：与其他诱导剂相比，在COVID-19危重患者中单次推注依托咪酯与插管后平均动脉压较低、住院时间和30天死亡率较高相关。
方法：国际，多中心，回顾性研究。
方法：来自美国和欧洲三大学术机构的因COVID-19而住院的重症患者。
方法：将患者分为依托咪酯（ET）组或其他诱导剂（OA）组。主要结果是插管后低血压。次要结果包括插管后炎症状态，住院死亡率，和30天的死亡率。
结果：纳入171例中位年龄为68（IQR58-73）岁的患者（ET，n=98；OA，n=73）。依托咪酯与插管后平均动脉压较低相关[74.33（64-85）mmHg与81.84（69.75-94.25）mmHg，与其他试剂相比，p=0.005]。在入住重症监护病房后7天和14天，两组之间的炎症标志物通常没有观察到统计学上的显着差异。住院死亡率[77（79%）对41（56%），p=0.003]和30天死亡率[78（80%）对43（59%），p=0.006]在ET组中较高。在多变量逻辑回归分析中，只有依托咪酯(p=0.009)和插管后平均动脉压(p<0.001)对死亡率有统计学意义的影响,与应激剂量类固醇相反（p=0.301），校正肌酐后（p=0.695），血尿素氮（p=0.153），年龄（p=0.055），血红蛋白氧饱和度（SpO2）（p=0.941），和吸入氧的分数(FiO2)(p=0.712)。
结论：与其他诱导剂相比，在COVID-19危重患者中单次推注依托咪酯与插管后平均动脉压较低、住院时间和30天死亡率较高相关。
