Etomidate use for RSI not linked to nosocomial infection

Use of etomidate for rapid sequence intubation (RSI) does not appear to increase the incidence of secondary infection, a study has shown.

Hospitalized patients who received either etomidate or control (ie, ketamine, propofol, or no agent) for RSI were included in the analysis. The incidence of secondary infections was the primary outcome. Secondary ones included the number of mechanical ventilator-free days within 28 days, 30-day mortality, length of hospital stay, and length of intensive care unit stay.

Four hundred thirty-four patients were reviewed, of which 129 (29.7 percent) met the eligibility criteria (n=94 etomidate; n=35 control). The etomidate group had a numerically higher incidence of secondary infection, but this did not reach statistical significance (38.7 percent vs 28.6 percent; p=0.447).

No significant between-group difference was observed in the secondary outcomes, but the patients in the control group had a longer hospital stay (14.0 vs 18.1; p=0.20) and a longer ICU stay (11.0 vs 14.1; p=0.030). In addition, patients treated with etomidate had a higher incidence of bacteraemia, albeit statistically nonsignificant (8 vs 0; p=0.17).

“To fully understand the effects of etomidate use and its subsequent adrenal suppression, larger studies are needed,” the researchers said.

“Etomidate is commonly used for induction of anaesthesia for RSI. It has little impact on haemodynamic status, making it a widely used agent. Due to the inhibition of cortisol production, etomidate causes adrenal suppression,” they explained.