Etomidate use in adult septic patients

Birtok, Tunde, Joyce Delaurentiis, and Sarah yang

DOES ETOMIDATE INFLUENCE MORTALITY IN ADULT PATIENTS WITH SEPSIS? A REVIEW OF THE LITERATURE.

 

Birtok, Tunde*; Delaurentiis, Joyce*; Yang, Sarah*; Conley, Joyce PhD, Faculty

University of Detroit Mercy, College of Health Professions

 

 

STATEMENT OF THE PROBLEM

 

In adult patients with sepsis, it is often necessary to intubate in order to maintain the airway, and the drug etomidate is widely used as anesthesia for this purpose. Etomidate may cause a decrease in corticotropin response which could contribute to mortality.

 

CLINICAL QUESTION

 

“Does etomidate (amidate) influence mortality in adult patients with sepsis?”

 

ACCEPTED PRACTICE/ SEARCH FOR EVIDENCE

 

An exhaustive search of the relevant literature available in Cinahl and PubMed, including peer reviewed journals like Chest, and Emergency Medicine revealed no existence of current standards of practice regarding etomidate use for endotracheal intubation in the adult septic patient. A total of nine articles were found. Three articles were excluded because they did not meet criteria. The remaining articles center in on the use of etomidate and its influence on mortality in the adult septic patient.

 

CRITICAL APPRAISAL OF THE EVIDENCE

 

Five of the six studies found that the use of etomidate during rapid sequence intubation in adult patients with sepsis was not statistically significant to cause an increase in mortality rate. Only one study showed an increase in mortality post administration of etomidate for induction in this cohort. Authors recommend caution to those healthcare workers who wish to use etomidate in adult patients with sepsis. Whether or not etomidate influences mortality in adult patients with sepsis remains unanswered. More studies need to be conducted.

 

CLINICAL PRACTICE IMPLICATIONS

 

Upon review of the literature, it is concluded that etomidate use as induction agent for adult patients with sepsis is an appropriate practice. The concern about adrenal suppression is less relevant, since it was shown to be transient, and it has not shown to adversely effect survival. When emergent airway securement is needed in an already hemodynamically unstable patient, etomidate has a safe pharmacologic profile and provides excellent induction conditions without further compromising tissue perfusion.