Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury

Keir J. Warner, Joseph Cuschieri, Gregory Jurkovich, Eileen M. Bulger

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

Background: Etomidate is an induction agent used for the rapid sequence intubation (RSI) of trauma patients because of its favorable hemodynamic profile and rapid onset. However, recent studies have shown etomidate to decrease circulating cortisol concentrations, potentially influencing inflammation. We hypothesized that etomidate may alter the occurrence of acute respiratory distress syndrome (ARDS) in injury victims. Methods: We analyzed data collected prospectively from a clinical trial of prehospital hypertonic saline administration. Post hoc, patients were grouped according to whether they did or did not receive etomidate for prehospital airway management. The incidence of ARDS was compared between the two groups by Fisher's exact test. Logistic regression was used to adjust for the effects of other known risk factors for ARDS. Results: Over a 2-year period, 94 study patients underwent RSI, of which 35 received etomidate (37%). There were no significant differences in demographic, physiology, anatomic injury scores, or use of hypertonic saline resuscitation between the groups. After adjusting for physiology, injury severity, and transfusion, etomidate use remained associated with ARDS (aOR = 3.9, 95% Cl =1.24-12.0). Conclusion: Single-dose etomidate for RSI in severely injured trauma patients is associated with increased ARDS and multiple organ dysfunction syndrome, in part, because of an effect of etomidate on the inflammatory response.

Original languageEnglish (US)
Pages (from-to)45-50
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume67
Issue number1
DOIs
StatePublished - Nov 4 2009
Externally publishedYes

Keywords

  • Acute respiratory distress syndrome
  • Etomidate
  • Intubation
  • Multiple organ dysfunction syndrome
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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