Single-dose etomidate does not increase mortality in patients with sepsis: a systematic review and meta-analysis of randomized controlled trials and observational studies.

@article{Gu2015SingledoseED,
  title={Single-dose etomidate does not increase mortality in patients with sepsis: a systematic review and meta-analysis of randomized controlled trials and observational studies.},
  author={Wan-Jie Gu and Fei Wang and Lu Tang and Jing-chen Liu},
  journal={Chest},
  year={2015},
  volume={147 2},
  pages={
          335-346
        }
}
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 of etomidate for rapid sequence intubation increased mortality in patients with sepsis. METHODS PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and observational studies regarding the effect of single-dose etomidate on mortality… 

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References

SHOWING 1-10 OF 48 REFERENCES
Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis*
TLDR
Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis.
Single-Dose Etomidate Is Not Associated With Increased Mortality in ICU Patients With Sepsis: Analysis of a Large Electronic ICU Database*
TLDR
In a mixed-diagnosis group of critically ill patients with sepsis, severe sepsi, and septic shock, single-dose etomidate administration for intubation in the ICU was not associated with higher mortality, shock, duration of mechanical ventilation, ICU or hospital length of stay, or vasopressor use.
Low-Dose Hydrocortisone Therapy Attenuates Septic Shock in Adult Patients but Does Not Reduce 28-Day Mortality: A Meta-Analysis of Randomized Controlled Trials
TLDR
Although low-dose hydrocortisone therapy ameliorates septic shock at 7 and 28 days, it does not reduce 28-day mortality.
A prospective observational study of the effect of etomidate on septic patient mortality and length of stay.
TLDR
No statistically significant increase in hospital LOS or mortality in patients given etomidate for rapid-sequence intubation was found, and suggestions that the use of etomidates for intubated patients in the emergency department be abandoned are not supported.
Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis
TLDR
In septic shock patients treated with hydrocortisone, etomidate did not decrease life-threatening complications following intubation, but when associated with hydrodisone it also did not impair outcome.
Etomidate use in severe sepsis and septic shock patients does not contribute to mortality
TLDR
This large retrospective multi-center study further supports the safety of etomidate use in severe sepsis and septic shock by finding no significant difference in mortality between etomidates and non-etomidate cohorts in this study.
The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock
TLDR
The use of bolus dose etomidate in the 72 h before study inclusion is associated with an increased incidence of inadequate response to corticotropin, but is also likely to be associated with a increase in mortality.
Corticosteroid after etomidate in critically ill patients: A randomized controlled trial*
TLDR
It is suggested that critically ill patients without septic shock do not benefit from moderate-dose hydrocortisone administered to overcome etomidate-related adrenal insufficiency.
...
...