Single-Dose Etomidate Does Not Increase Mortality in Patients with Sepsis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.

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Single-Dose Etomidate Does Not Increase Mortality in Patients with Sepsis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.

Chest. 2014 Sep 25;

Authors: Gu WJ, Wang F, Tang L, Liu JC

Abstract
ABSTRACT: Background:The effect of single-dose etomidate on mortality in patients with sepsis remains controversial. We systematically reviewed the literature to investigate whether a single-dose etomidate for rapid sequence intubation increased mortality in patients with sepsis. Methods:PubMed, Embase, and CENTRAL were searched for randomized controlled trials (RCTs) and observational studies regarding the effect of single-dose etomidate on mortality in adults with sepsis. The primary outcome was all-cause mortality. The Mantel-Haenszel method with random effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). Results:Eighteen studies (two RCTs and sixteen observational studies), involving 5552 patients, were included. Pooled analysis suggested that single-dose etomidate was not associated with increased mortality in patients with sepsis, both in RCTs (RR, 1.20; 95% CI, 0.84 to 1.72; P = 0.31; I2 = 0%) and observational studies (RR, 1.05; 95% CI, 0.97 to 1.13; P = 0.23; I2 = 25%). When only adjusted RRs were pooled in five observational studies, RR for mortality was 1.05 (95% CI, 0.79 to 1.39; P = 0.748; I2= 71.3%). These findings also were consistent across all subgroup analyses for observational studies. Single-dose etomidate increased the risk of adrenal insufficiency in patients with sepsis (eight studies; RR, 1.42; 95% CI, 1.22 to 1.64; P < 0.00001). Conclusions:Current evidence indicates that single-dose etomidate does not increase mortality in patients with sepsis. However, this finding largely relies on data from observational studies, potentially subject to selection bias, and hence high-quality and adequately powered RCTs are warranted.
Background: The effect of single-dose etomidate on mortality in patients with sepsis remains controversial. We systematically reviewed the literature to investigate whether a single-dose etomidate for rapid sequence intubation increased mortality in patients with sepsis.
Methods: PubMed, Embase, and CENTRAL were searched for randomized controlled trials (RCTs) and observational studies regarding the effect of single-dose etomidate on mortality in adults with sepsis. The primary outcome was all-cause mortality. The Mantel-Haenszel method with random effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).
Results: Eighteen studies (two RCTs and sixteen observational studies), involving 5552 patients, were included. Pooled analysis suggested that single-dose etomidate was not associated with increased mortality in patients with sepsis, both in RCTs (RR, 1.20; 95% CI, 0.84 to 1.72; P = 0.31; I2 = 0%) and observational studies (RR, 1.05; 95% CI, 0.97 to 1.13; P = 0.23; I2 = 25%). When only adjusted RRs were pooled in five observational studies, RR for mortality was 1.05 (95% CI, 0.79 to 1.39; P = 0.748; I2= 71.3%). These findings also were consistent across all subgroup analyses for observational studies. Single-dose etomidate increased the risk of adrenal insufficiency in patients with sepsis (eight studies; RR, 1.42; 95% CI, 1.22 to 1.64; P < 0.00001).
Conclusions: Current evidence indicates that single-dose etomidate does not increase mortality in patients with sepsis. However, this finding largely relies on data from observational studies, potentially subject to selection bias, and hence high-quality and adequately powered RCTs are warranted.

PMID: 25255427 [PubMed - as supplied by publisher]

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