Document Detail

Should etomidate be used for rapid-sequence intubation induction in critically ill septic patients?
MedLine Citation:
PMID:  18272107     Owner:  NLM     Status:  MEDLINE    
Etomidate is an agent often used by emergency medicine physicians for rapid-sequence intubation induction of critically ill patients because of its reliable pharmacokinetics and cardiovascular stability. Etomidate is known to inhibit endogenous cortisol production through inhibition of 11beta-hydroxylase. Previous studies in undifferentiated emergency department patients and healthy, elective surgical patients have shown this effect to be only transient and not clinically significant. Recent retrospective studies in the pediatric and adult intensive care literature have shown an association between a single induction dose of etomidate in critically ill septic patients and sustained suppression of the adrenal axis with an increase in mortality. It is unknown at this time if any increase in mortality associated with etomidate-induced adrenal suppression would be offset by concomitant corticosteroid administration. Aggressive resuscitation of septic patients with fluids, antibiotics, and vasopressors has been shown to significantly reduce mortality and may allow for the use of alternative agents that had previously been discouraged because of concern for hemodynamic collapse during intubation. A prospective randomized trial in septic patients of etomidate induction with early corticotropin stimulation testing or corticosteroid supplementation vs the use of alternative induction agents with enough power to detect differences in mortality is needed to further address this clinical dilemma.
Brian T Fengler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  26     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-14     Completed Date:  2008-02-28     Revised Date:  2008-08-14    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  229-32     Citation Subset:  IM    
Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800699, Charlottesville, VA 22908, USA.
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MeSH Terms
Anesthetics, Intravenous*
Critical Illness / therapy*
Intubation, Intratracheal*
Sepsis / therapy*
Reg. No./Substance:
0/Anesthetics, Intravenous; 33125-97-2/Etomidate
Comment In:
Am J Emerg Med. 2008 Jul;26(6):728-9; author reply 729-30   [PMID:  18606334 ]

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

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