Etomidate increases susceptibility to pneumonia in trauma patients.

Karim Asehnoune (1) , Pierre Joachim Mahe (1) , Philippe Seguin (2) , Samir Jaber (3) , Boris Jung (3) , Christophe Guitton (4) , Nolwen Chatel-Josse (1) , Aurelie Subileau (5) , Anne Charlotte Tellier (6) , Françoise Masson (7) , Benoit Renard (8) , Yannick Malledant (2) , Corinne Lejus (1) , Christelle Volteau (9) , Véronique Sébille (9) , Antoine Roquilly (1)

1 Service de Soins Intensifs et Anesthésie-Réanimation
2 Foie, métabolismes et cancer
3 Service de Soins Intensifs et Anesthésiologie
4 Service Réanimation Médicale Polyvalente
5 Service de Soins Intensifs
6 CHU Trousseau [APHP]
7 Service d'Anesthésie et de Réanimation 1
8 Médecine Interne et Réanimation Médicale
9 Biostatistique, Recherche Clinique et Mesures Subjectives en Santé

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.

Mots clés: Etomidate; Adrenal insufficiency; Bacterial pneumonia; Trauma; Hydrocortisone

Domaines: Hépatologie et Gastroentérologie

Karim Asehnoune, Pierre Joachim Mahe, Philippe Seguin, Samir Jaber, Boris Jung, et al.. Etomidate increases susceptibility to pneumonia in trauma patients.. Intensive Care Medicine, 2012, 38 (10), pp.1673-82. ⟨10.1007/s00134-012-2619-8⟩. ⟨inserm-00864906⟩