One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis

• Published in: Intensive care medicine Vol. 34; no. 1; pp. 163 - 168
• Main Authors: den Brinker, Marieke, Hokken-Koelega, Anita C. S., Hazelzet, Jan A., de Jong, Frank H., Hop, Wim C. J., Joosten, Koen F. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.01.2008; Springer; Springer Nature B.V
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Brief Report; Critical Care Medicine; Emergency and intensive care: infection, septic shock; Emergency Medicine; Enzymes; Glucose; Hormones; Hospitals; Intensive; Intensive care; Intensive care medicine; Intubation; Medical sciences; Medicine; Medicine & Public Health; Mortality; Pain Medicine; Pediatrics; Pharmacology. Drug treatments; Pneumology/Respiratory System; Respiratory system; Sepsis; Steroids; Netherlands; Critical illness; Adrenal insufficiency; Child; Etomidate; Meningococcal disease; Endocrinopathy; Human; Imidazole derivatives; Intensive care; Single dose; Meningococcal disease, Child; Etomidate, Critical illness; Infection; Sepsis syndrome; General anesthetic; Adrenal gland diseases; Bacteriosis; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-007-0836-3

Objective To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis. Design Retrospective study conducted between 1997 and 2004. Setting University-affiliated paediatric intensive care unit (PICU). Patients and participants Sixty children admitted to the PICU with meningococcal sepsis, not treated with steroids. Interventions Adrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12 h and 24 h. To assess disease severity, PRISM score and selected laboratory parameters were determined. Measurements and main results On admission, before blood was drawn, 23 children had been intubated with etomidate, 8 without etomidate and 29 were not intubated. Children who were intubated had significantly higher disease severity parameters than those not intubated, whereas none of these parameters significantly differed between children intubated with or without etomidate. Children who received etomidate had significantly lower cortisol, higher ACTH and higher 11-deoxycortisol levels than those who did not receive etomidate. Arterial glucose levels were significantly lower in children who were intubated with etomidate than in non-intubated children. When children were intubated with etomidate, cortisol levels were 3.2 times lower for comparable 11-deoxycortisol levels. Eight children died, seven of whom had received etomidate. Within 24 h cortisol/ACTH and cortisol/11-deoxycortisol ratios increased significantly in children who received etomidate, but not in children who did not, resulting in comparable cortisol/ACTH ratios with still significantly lowered cortisol/11-deoxycortisol ratios 24 h after admission. Conclusions Our data imply that even one single bolus of etomidate negatively influences adrenal function for at least 24 h. It might therefore increase risk of death.