Corticosteroid after Etomidate in Critically Ill Patients

Dalay, S.; Jagannathan, S.; Chadwick, Sean G.

doi:10.1177/175114371201300418

Cited by 2 publications

(8 citation statements)

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Section: Resultsmentioning

confidence: 99%

“…Of the seven studies, six assessed mortality (72–77); however, the corticosteroid used, dose, frequency, and duration of administration were not consistent across studies. There were two separate RCTs (72, 73). In one study patients received a 42-hour infusion of hydrocortisone 200 mg/day (350 mg total) (72) and in another trial, a 42-hour infusion of hydrocortisone (200 mg total) was administered (73) following etomidate administration for RSI.…”

Section: Resultsmentioning

confidence: 99%

“…In one study patients received a 42-hour infusion of hydrocortisone 200 mg/day (350 mg total) (72) and in another trial, a 42-hour infusion of hydrocortisone (200 mg total) was administered (73) following etomidate administration for RSI. Mortality rates did not differ between these trials (28-d mortality: 13% [hydrocortisone] vs 12% [control]) (72) and ICU mortality (3% [hydrocortisone] vs 5% [control]) (73). Two prospective, randomized, controlled substudies of patients who received etomidate for RSI evaluated the use of hydrocortisone versus placebo (74, 75).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies evaluated the association between the development of multiple organ dysfunction and the administration of hydrocortisone in patients who received etomidate as an induction agent for RSI (72, 73, 78). One prospective RCT randomized ICU patient to receive etomidate and rocuronium (group 1); etomidate, rocuronium, and methylprednisolone 2 mg/kg IV 2–4 minutes before etomidate administration (group 2); or midazolam and rocuronium (group 3) (78).…”

Section: Resultsmentioning

confidence: 99%

“…SOFA scores at 24 hours were significantly lower in all three groups, compared with baseline. The two prospective randomized, double-blind, controlled trials that evaluated the effect of hydrocortisone infused over a 42-hour time period showed that the proportion of patients with a SOFA score of 3 or 4 decreased over time in both the hydrocortisone group and the placebo group (72, 73). There was no difference between groups in the median SOFA score at 48 hours in either study.…”

Section: Resultsmentioning

confidence: 99%

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Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient

Acquisto,

Mosier,

Bittner

et al. 2023

Critical Care Medicine

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RATIONALE: Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). OBJECTIVES: To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. DESIGN: A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel’s inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process. METHODS: Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of “strong” or “conditional” were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist. RESULTS: From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence. CONCLUSIONS: Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.

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Section: Resultsmentioning

confidence: 99%