![]() ![]() The authors identified eighteen articles (two randomized control trials and sixteen observational studies) including a total of 5,552 patients. argue that while a one-time administration of etomidate likely induces adrenal insufficiency, this effect is not associated with increased mortality ( 9). In “Single-Dose Etomidate Does Not Increase Mortality in Patients with Sepsis”, published in CHEST earlier this year, Gu et al. In an effort to pool the available data, several groups have published meta-analyses and systematic reviews on this topic. ![]() However, the bulk of these investigations featured low enrollment and their results have been mixed therefore the clinical significance of etomidate’s induction of adrenal insufficiency in patients with septic shock remains unclear ( 8). Given the widespread usage of etomidate for RSI in critically ill patients (and therefore a large number of septic patients), studies have examined the effect of a single dose of etomidate on clinical outcome (mortality). In 2006, Annane and colleagues reported that a majority of patients with severe sepsis and septic shock demonstrated some degree of adrenal insufficiency ( 7). Further research in the late 1990s and early 2000s examined this phenomenon in critically ill patients and found consistent effects on cortisol production, but were insufficiently powered to detect differences in mortality ( 5, 6). Studies in humans examined etomidate use in patients undergoing elective surgeries, confirming in vivo suppression of the adrenal axis ( 4). Numerous studies identified the effect of etomidate on cortisol synthesis through inhibition of 11-beta hydroxylase ( 3). While it is also generally accepted that single dose etomidate likewise causes suppression of the adrenal axis, the clinical significance of this interaction remains poorly understood.Įtomidate was historically utilized as a constant infusion for sedation for mechanically ventilated patients, however data published in the early 1980s raised concern about its association with mortality ( 2). When utilized as an infusion, this effect can be profound enough to affect mortality ( 2). While this pharmacological profile makes it an attractive option for RSI, etomidate has been shown to cause adrenal suppression. ![]() Single-dose etomidate provides rapid and effective sedation with minimal acute hemodynamic effect ( 1). Rapid sequence induction (RSI) is a common practice used to facilitate endotracheal intubation in critically ill patients. Interviews with Outstanding Guest Editors.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process. ![]()
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