#Etomidate and mortality in critically ill patients

Etomidate is a common induction agent but controversy exists about its effects on outcomes

Our meta-analysis found a high probability that etomidate increases mortality (NNH 31)

🧵Thread 1/6 🔗sciencedirect.com/science/articl… #FOAMcc Image
2/

PICOS of this SR/MA

P: Critically ill patients
I: #Etomidate as an induction agent for intubation
C: Any comparator
O: Mortality at the main timepoint defined by authors
S: Randomized controlled trials

11 RCTs with 2704 patients were included

#FOAMcc Image
3/

#Etomidate was associated with significantly increased mortality (23% vs 20%; risk ratio = 1.16 [1.01–1.33]; P = 0.03)

The number needed to harm was 31

The probabilities of any increase and a 1% increase (NNH ≤100) in mortality were 98.1% and 92.1%, respectively.

#FOAMcc ImageImage
4/

Sensitivity analyses confirmed main results

Direction/magnitude consistent for mortality at longest follow-up available even if statistical significance was lost (27% vs 25%; RR=1.07 [0.95–1.21]; P=0.27), corresponding to 86% probability of any harm from #Etomidate

#FOAMcc ImageImage
5/

#Etomidate was associated with a significantly increased risk of adrenal insufficiency (21% vs. 10%; risk ratio = 2.01 [1.59–2.56]; P < 0.001), confirming the findings of previous meta-analyses.

#FOAMcc Image
6/

🔹Our meta-analysis showed a high likelihood that etomidate was associated with an increased risk of mortality and adrenal insufficiency

🔹Future research is warranted to investigate the optimal induction strategy for critically ill patients

#FOAMcc

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with San Raffaele Anesthesia and Intensive Care

San Raffaele Anesthesia and Intensive Care Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @SRAnesthesiaICU

Jun 16, 2023
We've just presented and published a multicenter RCT at #CCR23 and in @JAMA_current!

Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!

🔗 jamanetwork.com/journals/jama/…

This 🧵 will explain the study in detail /11

#FOAMcc Image
2/

β-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.

In fact, several meta-analyses reported reduced mortality when administered continuously. Image
3/

Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis Image
Read 11 tweets
Apr 18, 2023
🚫 DON’T use glucocorticoids in oxygen-free #COVID19 pts

Just published @NEJMEvidence
 
Guidelines are against glucocorticoids in pts not on O2 but effect on survival remains unclear
 
Our meta-analysis found that glucocorticoids increase mortality

🔗eviden.cc/3MnrDSA 1/5 Image
2/

📝 STUDY SELECTION
 
P: adults with #COVID19 not receiving oxygen
I: intravenous or oral #glucocorticoids
C: any
O: all-cause mortality at the longest follow-up available
S: RCTs, matched studies
 
➡️ 5 RCTs and 1 propensity-matched study (total 6634 pts) were included Image
3/

🪦 MORTALITY: #Glucocorticoids vs comparator

14% vs 10% (OR=1.56; 95% CI=1.27 to 1.93)
Number needed to harm=27
 
Mortality increase was confirmed in RCTs only
16% vs 13% (OR=1.34; 95% CI=1.00 to 1.78)
 
Need for mechanical ventilation was also increased: 18% vs 15%

#FOAMcc Image
Read 5 tweets
Apr 17, 2023
Our @MarinaPieri4 now presenting at @EACTAIC webinar: native heart recovery is the first choice option! ImageImageImageImage
2 RCTs are running on #levosimendan in VE #ECMO weaning @EACTAIC

Dieter Dauwe Image
In a patient with #ECPELLA #ECMELLA

Which device do you wean first?
#ECMO or #IMPELLA

Dieter Dauwe @DauweDieter
@EACTAIC @MarinaPieri4 Image
Read 7 tweets
Jun 18, 2021
Inoperable patients can now be offered a potentially curative surgery.

🔗 Read @annalsthorsurg: pubmed.ncbi.nlm.nih.gov/34111383/ and the thread 👇 #FOAMcc #FOAMecmo
2/

Here we report the 1st case of intraoperative use of VA-#ECMO in a patient with resectable lung cancer and bivasal critical coronary artery disease with prohibitive low EF (23%), and describe the benefits of this new indication.

🔗 pubmed.ncbi.nlm.nih.gov/34111383/ #FOAMcc #FOAMecmo
3/

Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk.
Read 8 tweets
Jan 21, 2021
1/

In non-COVID-19 pneumonia/ARDS filling defects are found in pulmonary arteries branches vascularizing healthy lung segments. Instead, in #COVID19 there is an almost perfect topographical overlap of filling defects distribution & pneumonia extent.

🔗 jcvaonline.com/article/S1053-…
2/

We demonstrated that pulmonary vascular thrombosis in #COVID19 is due to local inflammatory endothelial damage with a superimposed thrombotic late complication and not to recurrent thromboembolism from peripheral deep vein thrombosis.

#MicroCLOTS
3/

51% of pts showed pulmonary vascular thrombosis, with a median time from symptoms of 18 days.

We identified a specific radiological pattern of #COVID19 pneumonia with a unique spatial distribution of pulmonary vascular thrombosis overlapping areas of ground-glass opacities.
Read 7 tweets
Aug 3, 2020
How we’ll we manage the first ten #COVID19 patients of 2021 (if any) hospitalized for #ARDS (compared to the first 10 patients we managed in February 2020). A multidisciplinary brain storming after managing approx 1000 such patients within the end of Apr 2020. A thread 1/ #FOAMed Image
2/
Not all our clinical impressions have already published evidence (but the majority was published), but our hospital #COVID19 mortality went close to zero in late April 2020 and we hope medical management accounts for at least part of these results.
3/
More, early ECMO. We put a dozen ECMO. We feel we should have put more of them and we should have done it earlier (eg after a couple of days of invasive mechanical ventilation with no improvement). @annamarascandro
@mgcalabroMD @md_monaco @MarinaPieri4
hsr.it/news/2020/magg…
Read 11 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(