| Should etomidate be used for rapid-sequence intubation induction in critically ill septic patients? | |
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MedLine Citation:
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PMID: 18272107 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Brian T Fengler |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of emergency medicine Volume: 26 ISSN: 1532-8171 ISO Abbreviation: Am J Emerg Med Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-14 Completed Date: 2008-02-28 Revised Date: 2008-08-14 |
Medline Journal Info:
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Nlm Unique ID: 8309942 Medline TA: Am J Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 229-32 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800699, Charlottesville, VA 22908, USA. bf4j@hscmail.mcc.virginia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthetics, Intravenous* Critical Illness / therapy* Etomidate* Humans Intubation, Intratracheal* Sepsis / therapy* |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 33125-97-2/Etomidate |
| Comments/Corrections | |
Comment In:
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Am J Emerg Med. 2008 Jul;26(6):728-9; author reply 729-30
[PMID:
18606334
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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