Single-Dose Etomidate Does Not Increase Mortality in Patients with Sepsis A Systematic Review and Me
Single-Dose Etomidate Does Not Increase Mortality in Patients with Sepsis A Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies. Wan-Jie Gu , MSc et. al. Chest. 2015; 335-346
A meta-analysis of 2 randomized controlled studies (RCT) and 16 observational studies looking to see whether a single dose of etomidate used in RSI contributes to the primary outcome of mortality in sepsis.
A meta-analysis was performed to assess whether one dose of etomidate contributes to increased mortality in patients with sepsis. Eighteen studies (two RCTs and 16 observational studies) in 5,552 patients were
Included looking at the primary outcome of mortality and the secondary outcomes of adrenal insufficiency, length of stay, length of ICU stay, and duration of mechanical ventilation. No significant heterogeneity was observed between the studies included.
No significant difference was found with regards to the primary outcome with pooled analyses showing RR 1.2 with 95% CI 0.84-1.72 in the RCT group and RR 1.05 with 95% CI 0.97-1.13 in the observational studies. Pooled analyses were not able to be performed on the secondary outcomes.
This meta-analysis showed no difference in mortality but was limited given that it only included 2 RCT’s, only included adult patients, and included studies that had differing definitions of “sepsis.” Previous meta-analyses have shown a significant difference in mortality for septic patients receiving etomidate. Given lack of strong evidence for either side of the argument physicians may want to consider alternate sedation options when intubating septic patients.