etomidate

[Bostonredsox]

http://www.medscape.com/viewarticle/774419

Have ready several of the prior papers that were in CHEST and in NEJM, to my recollection, all of them showed there was no change in mortality with RSI using etomidate depsite their being a measurable difference in adrenal supression. Apparently the meta-analysis showed something different.

Granted the meta-analysis on Xigris showed actual outcomes in subgroups compared to the original PROWESS trial....shows just how useful meta-analysis' are.

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[iridesingltrack]

I advise caution in interpreting this paper. If you read the Cuthbertson paper, which is primarily responsible for the observed effect in the meta-analysis, you will note that it was a retrospective review of the CORTICUS data. Chan et al include it despite excluding other papers in the final tables because of not being RCTs. Fundamentally, the Cuthbertson paper is mislabeled an RCT in the meta-analysis. This is a pretty significant error in my mind. Had they only used RCTs of etomidate in sepsis, as they imply they did, the conclusion would be different. Honestly, I am shocked this was missed by the reviewers. This is the only problem with meta-analyses, garbage in garbage out.

iride

 

[Bostonredsox]

Update from this months SCCM, which even without paying for, I susprisingly can read via my new ipad app, wonder if its a hiccup in their system...

http://www.ncbi.nlm.nih.gov/pubmed/23318491