Rationale: Uncertainty remains regarding the risks associated with single-dose use of etomidate. Objectives: To assess the use of etomidate in critically ill patients and compare outcomes for patients who received etomidate versus ketamine. Methods: We assessed patients who received invasive mechanical ventilation (IMV) and were admitted to an ICU in the Premier Healthcare Database between 2008 and 2021. The exposure was receipt of etomidate on the day of IMV initiation, and the main outcome was hospital mortality. Using multivariable regression, we compared patients who received IMV within the first 2 days of hospitalization who received etomidate with propensity score-matched patients who received ketamine. We also assessed whether receipt of corticosteroids in the days after intubation modified the association between etomidate and mortality. Measurements and Main Results: Of 1,689,945 patients who received IMV, nearly half (738,855; 43.7%) received etomidate. Among those who received IMV in the first 2 days of hospitalization, we established 22,273 matched pairs administered either etomidate or ketamine. In the primary analysis, receipt of etomidate was associated with greater hospital mortality relative to ketamine (21.6% vs. 18.7%; absolute risk difference, 2.8%; 95% confidence interval, 2.1%, 3.6%; adjusted odds ratio, 1.28, 95% confidence interval, 1.21,1.34). This was consistent across subgroups and sensitivity analyses. We found no attenuation of the association with mortality with receipt of corticosteroids in the days after etomidate use. Conclusions: Use of etomidate on the day of IMV initiation is common and associated with a higher odds of hospital mortality than use of ketamine. This finding is independent of subsequent treatment with corticosteroids.

中文翻译：

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危重患者依托咪酯使用与氯胺酮相比与死亡率的相关性评估。


理由：与单剂量使用依托咪酯相关的风险仍然存在不确定性。研究目的： 评估依托咪酯在危重患者中的使用情况，并比较接受依托咪酯与氯胺酮治疗的患者的结局。方法： 我们评估了 2008 年至 2021 年间接受有创机械通气 （IMV） 并入住 Premier Healthcare Database 中的 ICU 的患者。暴露是在 IMV 开始当天接受依托咪酯，主要结局是住院死亡率。使用多变量回归，我们将住院前 2 天内接受 IMV 治疗的患者与接受依托咪酯治疗的患者与倾向评分匹配的氯胺酮治疗患者进行了比较。我们还评估了插管后几天接受皮质类固醇是否改变了依托咪酯与死亡率之间的关联。测量和主要结果： 在接受 IMV 的 1,689,945 名患者中，近一半 （738,855;43.7%） 接受了依托咪酯治疗。在住院前 2 天接受 IMV 的患者中，我们建立了 22,273 对匹配的依托咪酯或氯胺酮给药对。在初步分析中，相对于氯胺酮，接受依托咪酯与更高的住院死亡率相关 （21.6% vs. 18.7%;绝对风险差，2.8%;95% 置信区间，2.1%，3.6%;调整比值比，1.28,95% 置信区间，1.21,1.34）。这在亚组和敏感性分析中是一致的。我们发现在使用依托咪酯后几天内接受皮质类固醇与死亡率的相关性没有减弱。结论： 在 IMV 开始当天使用依托咪酯很常见，并且与使用氯胺酮相比，住院死亡率更高。这一发现与随后的皮质类固醇治疗无关。