在危急病患者中,对埃托米达的使用和与凯他明相比死亡率的关联的评估
Hannah Wunsch1,2,3,4, Nicholas A Bosch5,6, Anica C Law5
1Department of Anesthesiology, Weill Cornell Medicine, New York, New York.
American journal of respiratory and critical care medicine
|August 22, 2024
概括
在接受侵入性机械通风 (IMV) 的重症患者中,单剂量埃托米达的使用是常见的. 埃托米达与较高的医院死亡率有关,与胺相比,无论使用皮质类固醇.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 关于单剂量埃托米达的安全性和风险存在不确定性.
- 埃托米达经常用于在重症监护室 (ICU) 诱导侵入性机械通风 (IMV).
- 埃托米达和替代药物,如胺之间的比较结果数据是有限的.
研究的目的:
- 评估需要IMV的重症患者中埃托米达的利用模式.
- 为了比较接受etomidate与ketamine用于IMV启动的患者之间的医院死亡率.
- 调查皮质类固醇的潜在修饰作用的管理在etomidate和死亡率之间的关联.
主要方法:
- 从首席医疗保健数据库 (2008-2021) 获得IMV的1,689,945名患者的回顾性分析.
- 倾向性得分匹配分析比较了22273对在IMV启动之日接受埃托米达特或胺的患者.
- 多变量回归模型评估了埃托米达使用与医院死亡率之间的关联,调整了混因素,并探索了皮质类固醇使用.
主要成果:
- 埃托米达被用于43.7%的患者接受IMV.
- 与胺相比,使用埃托米达与医院死亡率显著增加有关 (21.6%与18.7%;aOR,1.28;95%CI,1.21-1.34).
- 随着埃托米达的增加,死亡风险在各个子组中保持一致,随后使用皮质类固醇并没有减弱.
结论:
- 在IMV启动之日使用埃托米达在重症患者中很普遍.
- 与胺相比,埃托米达的使用与医院死亡率的增加有关.
- 这种关联不管随后的皮质类固醇治疗如何,都会持续存在,这凸显了埃托米达在这个人群中的潜在风险.
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