Risk factors for mortality in septic patients who received etomidate

To characterize risk factors for mortality in septic patients who received etomidate for rapid sequence intubation.

This study was a retrospective cohort conducted at a large, tertiary, urban, academic medical center that included patients with severe sepsis or septic shock who received etomidate between January 1, 2010, and December 31, 2012.

A total of 169 patients were included with similar baseline characteristics. There were more men in the nonsurvivor group than in the survivor group (67.1% vs 50.6%, P=.03). Septic shock occurred in 91.5% of nonsurvivors and 69% of survivors (P<.01). Nonsurvivors also had a higher initial lactate of (5.1±4.3 mmol/L vs 3.6±3.4 mmol/L, P=.02) and more vasopressor therapy (91.5% vs 69%, P<.01), required a higher number of vasopressors (2.2±1.1 vs 1.3±1, P<.01), and were administered hydrocortisone (53.7% vs 34.5%, P=.01). Abdominal source of sepsis (P=.048) and number of vasopressors (P=.01) were predictive of 30-day mortality.

An alternative sedative induction agent may be considered for use in rapid sequence intubation in patients on multiple vasopressors or with abdominal source of infection.