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Etomidate and mortality in cirrhotic patients with septic shock.doc

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Etomidate and mortality in cirrhotic patients with septic shock

Cherfanetal.BMCClinicalPharmacology2011,11:22 /1472-6904/11/22 RESEARCH ARTICLE OpenAccess Etomidateandmortalityincirrhoticpatientswith septicshock AntoineJCherfan1,HaniMTamim2,AbdulrahmanAlJumah3,AsgarHRishu4,AbdulmajeedAl-Abdulkareem5, BandarAAlKnawy6,AliHajeer7,WaleedTamimi8,RietteBrits4andYaseenMArabi9* Abstract Background:Clinicaleffectsandoutcomesofasingledoseetomidatepriortointubationintheintensivecare settingiscontroversial.Theaimofthisstudyistoevaluatetheassociationofasingledoseeffectofetomidate priortointubationonthemortalityofsepticcirrhoticpatientsandtheimpactofthesubsequentuseoflowdose hydrocortisone. Methods:Thisisanested-cohortstudywithinarandomizeddoubleblindplacebocontrolledstudyevaluatingthe useoflowdosehydrocortisoneincirrhoticsepticpatients.Cirrhoticsepticpatients≥18yearswereincludedinthe study.Patientswhoreceivedetomidatepriortointubationwerecomparedtothosewhodidnotreceive etomidateforallcause28-daymortalityasaprimaryoutcome. Results:Sixtytwointubatedpatientsoutofthe75patientsrandomizedintheinitialtrialwereeligibleforthis study.Twentythreeofthe62intubatedpatientsreceivedetomidatedosepriortointubation.Etomidateusewas notassociatedwithallcause28-daymortalityorhospitalmortalitybutwasassociatedwithsignificantlyhigherICU mortality(91%vs.64%foretomidateandcontrolsgroups,respectively;p=0.02).Etomidatepatientswhoreceived subsequentdosesofhydrocortisonerequiredlowerdosesofvasopressorsandhadmorevasopressor-freedaysbut noimprovementinmortality. Conclusions:Inthisgroupofsepticcirrhoticpatientswithveryhighmortality,etomidateincreasedICUmortality. Subsequentuseofhydrocortisoneappearstohavenobenefitbeyonddecreasingvasopressorrequirements.The lowestmortalitywasobservedinpatientswhodidnotreceiveetomidatebutreceivedhydrocortisone. Background aretheclinicaleffectsandoutcomesassociatedwiththe Hypoxemia, hypotension, volume depletion are com- useofasingledoseintravenousadministrationofetomi- monlypresentinsepticshockpatientsandinductionof datepriortointubat