%0 Multicenter Study
%T Effects of Etomidate on Postintubation Hypotension, Inflammatory Markers, and Mortality in Critically Ill Patients with COVID-19: An International, Multicenter, Retrospective Study.
%A Leou K
%A Mendez D
%A Horani G
%A Papagiannakis N
%A Jiménez Sánchez R
%A Mazzei D
%A Mora I
%A Manickam R
%A Tourlakopoulos K
%A Garrido Peñalver JF
%A Jiménez Medina D
%A Rodríguez Mulero MD
%A Annousis K
%A Laou E
%A García de Guadiana-Romualdo L
%A Pantazopoulos I
%A Kaur K
%A Chalkias A
%A  
%J J Intensive Care Med
%V 38
%N 10
%D 2023 Oct 7
%M 37151026
%F 2.889
%R 10.1177/08850666231173847
%X <B>UNASSIGNED: </B>To evaluate the association of etomidate with postintubation hypotension, inflammation, and mortality in critically ill patients with COVID-19.<BR><B>METHODS: </B>International, multicenter, retrospective study.<BR><B>METHODS: </B>Critically ill patients hospitalized specifically for COVID-19 from three major academic institutions in the US and Europe.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.