Comparison of the effects of etomidate, ketamine, sodium thiopental, and midazolam on the mortality of patients with COVID-19 requiring intubation

Edalatkhah, Abbas; Kazemi, Mohammad Reza; Akhoundimeybodi, Zohreh; Seyedhosseini, Seyed Mohsen; Rostami, Soheila; Hosseini, Bibi Vaghihe; Akhondi, Zohreh; Ghelmani, Yaser

doi:10.47176/mjiri.35.49

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…A retrospective study published in 2021 reported that the use of etomidate was associated with a higher risk of mortality in this population. 13 Another study with COVID-19 patients reported that etomidate possibly contributed to postintubation hemodynamic instability and cardiac arrest. 14 In the present multicenter study, etomidate was associated with lower postintubation MAP, compared to other agents, despite the lower pre-intubation APACHE II score and systolic shock index in the ET group.…”

Section: Discussionmentioning

confidence: 99%

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

Leou,

Mendez,

Horani

et al. 2023

J Intensive Care Med

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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 (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.

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Section: Discussionmentioning

confidence: 99%

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

Leou,

Mendez,

Horani

et al. 2023

J Intensive Care Med

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“…This practice has been related to a greater number of days of mechanical ventilation and episodes of delirium in ICU patients. 37,38 Several hypotheses associated with the neurotropism of the virus due to episodes of hyperexcitation and agitation have been proposed, 39 which explains the need for deep sedation in patients in the initial phases of ARDS in order to achieve protective ventilation goals. In our study we found a median dose difference between approaches of 5.7 mg/h, which compared with those who received inhaled sedation, who did not require benzodiazepines, suggests a possible decrease in these complications described; however, the reduction we found was not statistically significant in the inhaled sedation group, RR 0.8 (95% CI 0.61-1.15, P ¼ .25).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19

et al. 2022

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BACKGROUND: Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented. 1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses. 2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (6 200 lg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. RESULTS: A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, P 5 .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, P < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, P 5 .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 lg/h or 1,200 lg/d (2.2 ampules/d, P < .001), and that of midazolam dose was 5.7 mg/h. CONCLUSIONS: Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.

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The impact of ketamine on emergency rapid sequence intubation: a systematic review and meta-analysis

Hu,

Liu,

et al. 2024

BMC Emerg Med

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Comparison of the effects of etomidate, ketamine, sodium thiopental, and midazolam on the mortality of patients with COVID-19 requiring intubation

Cited by 6 publications

References 14 publications

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

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

Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19

The impact of ketamine on emergency rapid sequence intubation: a systematic review and meta-analysis

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