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Does etomidate increase vasopressor requirements in patients needing mechanical ventilation?
Mary Elliot1, Glen Brown, I Fan Kuo
1, BScPharm, ACPR, is a Clinical Pharmacist with Vancouver General Hospital, Vancouver, British Columbia.
The Canadian Journal of Hospital Pharmacy
|August 25, 2012
Summary
Single-dose etomidate, used for intubation, does not increase vasopressor needs in critically ill patients. This study found no significant difference in hemodynamic support 24 hours post-administration.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Emergency Medicine
Background:
- Etomidate is a common induction agent for rapid-sequence intubation.
- Its use is linked to transient adrenal insufficiency, with debated clinical impacts in critically ill patients.
Purpose of the Study:
- To investigate if etomidate use correlates with increased vasopressor requirements compared to other induction agents.
- The study focused on a 24-hour time point after induction in mechanically ventilated patients.
Main Methods:
- Retrospective observational study using electronic health records.
- Matched 50 etomidate patients with controls based on shock cause, APACHE II score, age, and sex.
- Vasopressor doses (norepinephrine equivalents) at 24 hours post-intubation served as a hemodynamic instability marker.
Main Results:
- Mean vasopressor dose was 4 μg/min for etomidate vs. 3 μg/min for controls (p=0.61).
- Vasopressor use at 24 hours was observed in 12 etomidate patients and 16 controls (OR 2.3, p=0.34).
Conclusions:
- Single-dose etomidate does not appear to negatively impact hemodynamic stability.
- The dose of vasopressors required 24 hours post-administration was not significantly different between etomidate and other induction agents.
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