Original

Intensive Care Medicine

, Volume 38, Issue 10, pp 1673-1682

Etomidate increases susceptibility to pneumonia in trauma patients

  • Karim AsehnouneAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu–HME, University Hospital of NantesService d’anesthésie réanimation, CHU de Nantes Email author 
  • , Pierre Joachim MaheAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu–HME, University Hospital of Nantes
  • , Philippe SeguinAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Rennes
  • , Samir JaberAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi University Hospital of Montpellier
  • , Boris JungAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi University Hospital of Montpellier
  • , Christophe GuittonAffiliated withMedical Intensive Care Unit, University Hospital of Nantes
  • , Nolwen Chatel-JosseAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu–HME, University Hospital of Nantes
  • , Aurelie SubileauAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Brest
  • , Anne Charlotte TellierAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Tours
    • , Françoise MassonAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Bordeaux
    • , Benoit RenardAffiliated withIntensive Care Unit, Hospital of La Roche Sur Yon
    • , Yannick MalledantAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Rennes
    • , Corinne LejusAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu–HME, University Hospital of Nantes
    • , Christelle VolteauAffiliated withCellule de Biostatistique, EA 4275, UFR de Pharmacie, University of Nantes
    • , Véronique SébilleAffiliated withCellule de Biostatistique, EA 4275, UFR de Pharmacie, University of Nantes
    • , Antoine RoquillyAffiliated withIntensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu–HME, University Hospital of Nantes

Abstract

Purpose

To investigate the impact of etomidate on the rate of hospital-acquired pneumonia (HAP) in trauma patients and the effects of hydrocortisone in etomidate-treated patients.

Methods

This was a sub-study of the HYPOLYTE multi-centre, randomized, double-blind, placebo-controlled trial of hydrocortisone in trauma patients (NCT00563303). Inclusion criterion was trauma patient with mechanical ventilation (MV) of ≥48 h. The use of etomidate was prospectively collected. Endpoints were the results of the cosyntropin test and rate of HAP on day 28 of follow-up.

Results

Of the 149 patients enrolled in the study, 95 (64 %) received etomidate within 36 h prior to inclusion. 79 (83 %) of 95 patients receiving etomidate and 34 of the 54 (63 %) not receiving etomidate had corticosteroid insufficiency (p = 0.006). The administration of etomidate did not alter basal cortisolemia (p = 0.73), but it did decrease the delta of cortisolemia at 60 min (p = 0.007). There was a correlation between time from etomidate injection to inclusion in the study and sensitivity to corticotropin (R 2 = 0.19; p = 0.001). Forty-nine (51.6 %) patients with etomidate and 16 (29.6 %) patients without etomidate developed HAP by day 28 (p = 0.009). Etomidate was associated with HAP on day 28 in the multivariate analysis (hazard ratio 2.48; 95 % confidence interval 1.19–5.18; p = 0.016). Duration of MV with or without etomidate was not significantly different (p = 0.278). Among etomidate-exposed patients, 18 (40 %) treated with hydrocortisone developed HAP compared with 31 (62 %) treated with placebo (p = 0.032). Etomidate-exposed patients treated with hydrocortisone had fewer ventilator days (p < 0.001).

Conclusions

Among the patients enrolled in the study, etomidate did not alter basal cortisolemia, but it did decrease reactivity to corticotropin. We suggest that in trauma patients, etomidate is an independent risk factor for HAP and that the administration of hydrocortisone should be considered after etomidate use.

Keywords

Etomidate Adrenal insufficiency Bacterial pneumonia Trauma Hydrocortisone