Document Detail


Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients.
MedLine Citation:
PMID:  18209154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Timely diagnosis and treatment of adrenal insufficiency (AI) dramatically reduces mortality in trauma patients. We sought to identify risk factors and populations with a high risk of developing AI. DESIGN: Retrospective registry study. SETTING: Academic level I trauma center. PATIENTS: All trauma patients in the intensive care unit who underwent cosyntropin stimulation testing (CST) for presumed AI from January 1, 2002, through December 31, 2004. INTERVENTIONS: Cosyntropin stimulation testing, in which response was defined as an increase of 9 mug/dL (248 nmol/L) or more in cortisol level. MAIN OUTCOME MEASURES: Risk factors for developing AI in critically ill trauma patients. RESULTS: In 137 patients, CST was performed; 83 (60.6%) were nonresponders and 54 (39.4%) were responders. Age, sex, race, trauma mechanism, Injury Severity Score, and Revised Trauma Score were not statistically different between the groups. Rates of sepsis/septic shock, mechanical ventilation, and mortality were also similar between the 2 groups. However, rates of hemorrhagic shock on admission (45 [54%] vs 16 [30%]), requirement of vasopressor support (65 [78%] vs 28 [52%]), and etomidate exposure (59 [71%] vs 28 [52%]) were all significantly higher in the nonresponder group (P < .01). The increased risk of AI remained after controlling for potential confounding covariates (age, mechanism, Injury Severity Score, and Revised Trauma Score). CONCLUSIONS: Exposure to etomidate is a modifiable risk factor for the development of AI in this sample of critically injured patients. The use of etomidate for procedural sedation and rapid-sequence intubation in this patient population should be reevaluated.
Authors:
Bryan A Cotton; Oscar D Guillamondegui; Sloan B Fleming; Robert O Carpenter; Shivani H Patel; John A Morris; Patrick G Arbogast
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  143     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-22     Completed Date:  2008-02-05     Revised Date:  2009-01-02    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  62-7; discussion 67     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S, 404 Medical Arts Bldg, Nashville, TN 37212, USA. bryan.cotton@vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Academic Medical Centers
Adolescent
Adrenal Insufficiency / chemically induced*,  mortality*,  physiopathology
Adult
Aged
Cosyntropin / diagnostic use
Etomidate / adverse effects*,  therapeutic use
Female
Follow-Up Studies
Humans
Hypnotics and Sedatives / adverse effects,  therapeutic use
Injury Severity Score
Intubation, Intratracheal
Male
Middle Aged
Multiple Trauma / diagnosis*,  mortality,  therapy*
Poisson Distribution
Probability
Registries
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Analysis
Trauma Centers
Chemical
Reg. No./Substance:
0/Hypnotics and Sedatives; 16960-16-0/Cosyntropin; 33125-97-2/Etomidate
Comments/Corrections
Comment In:
Arch Surg. 2008 Dec;143(12):1147-8   [PMID:  19075164 ]
Arch Surg. 2008 Aug;143(8):808-9; author reply 809   [PMID:  18711047 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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