| Use of etomidate as an induction agent for rapid sequence intubation in a pediatric emergency department. | |
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MedLine Citation:
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PMID: 16636355 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Although etomidate is widely used for rapid sequence intubation (RSI), there is no consensus on the optimal induction agent and no prospective pediatric emergency department (ED) study exists. The objective of this study was to assess the effectiveness and safety of etomidate as an induction agent for RSI in the pediatric ED. METHODS: Data on RSI conditions and complications were collected prospectively on patients undergoing RSI in a tertiary pediatric ED from January 2003 to December 2003. ED hemodynamic data and inpatient data were collected retrospectively via chart review. RESULTS: Seventy-seven of 101 patients requiring intubation underwent RSI with etomidate. The mean (+/- SD) age was 8.2 (+/- 6.2) years. All 77 patients were successfully intubated. Intubation condition data were available for 69 of 77 patients (89.6%). Conditions were good in 68 of 69 (99%; 95% confidence interval = 92.2% to 99.9%). The mean (+/- SD) maximal percent decrease in systolic blood pressure was 10% (+/- 13.6%). A greater than 20% maximal percent decrease in systolic blood pressure occurred in 12 of 69 patients (17.4%; 95% confidence interval = 9.3% to 28.4%). There was no relationship between seizures after etomidate administration and prior seizure history (p = 0.25). Corticosteroids were given to 29 of 77 patients post-RSI for varying diagnoses. All eight patients given corticosteroids for shock were in shock at the time of intubation. CONCLUSIONS: In the pediatric ED setting, etomidate as an induction agent provided successful RSI conditions and resulted in varied hemodynamic changes that were especially favorable in those patients presenting in decompensated shock. Hypotension and seizures were uncommon and occurred in patients with confounding diagnoses. Until the significance of a single dose of etomidate on adrenal dysfunction is further clarified, caution should be used in those patients at risk for adrenal insufficiency. |
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Authors:
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Noel S Zuckerbraun; Raymond D Pitetti; Sandra M Herr; Kimberly R Roth; Barbara A Gaines; Christopher King |
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Publication Detail:
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Type: Clinical Trial; Journal Article Date: 2006-04-24 |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 13 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2006 Jun |
Date Detail:
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Created Date: 2006-06-01 Completed Date: 2006-07-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 602-9 Citation Subset: IM |
Affiliation:
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Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA. zuckns@chp.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adrenal Cortex Hormones / therapeutic use Adult Blood Pressure / drug effects Child Child, Preschool Emergency Medicine / methods* Emergency Service, Hospital* Etomidate / therapeutic use* Female Heart Rate / drug effects Humans Hypnotics and Sedatives / therapeutic use* Hypotension / chemically induced Infant Infant, Newborn Intubation, Intratracheal / adverse effects, methods* Male Pediatrics / methods* Prospective Studies Seizures / chemically induced Shock / etiology, therapy Survival Analysis Treatment Outcome Wounds and Injuries / complications, therapy |
| Chemical | |
Reg. No./Substance:
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0/Adrenal Cortex Hormones; 0/Hypnotics and Sedatives; 33125-97-2/Etomidate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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