{Reference Type}: Multicenter Study
{Title}: Effects of Etomidate on Postintubation Hypotension, Inflammatory Markers, and Mortality in Critically Ill Patients with COVID-19: An International, Multicenter, Retrospective Study.
{Author}: Leou K;Mendez D;Horani G;Papagiannakis N;Jiménez Sánchez R;Mazzei D;Mora I;Manickam R;Tourlakopoulos K;Garrido Peñalver JF;Jiménez Medina D;Rodríguez Mulero MD;Annousis K;Laou E;García de Guadiana-Romualdo L;Pantazopoulos I;Kaur K;Chalkias A; ;
{Journal}: J Intensive Care Med
{Volume}: 38
{Issue}: 10
{Year}: 2023 Oct 7
{Factor}: 2.889
{DOI}: 10.1177/08850666231173847
{Abstract}: <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.