Duration of adrenal inhibition following a single dose of etomidate in critically ill patients

• Published in: Intensive care medicine Vol. 34; no. 4; pp. 714 - 719
• Main Authors: Vinclair, Marc, Broux, Christophe, Faure, Patrice, Brun, Julien, Genty, Céline, Jacquot, Claude, Chabre, Olivier, Payen, Jean-François
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2008; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Adrenal Cortex Function Tests; Adrenal Insufficiency; Adrenal Insufficiency - chemically induced; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Anesthetics, Intravenous; Anesthetics, Intravenous - adverse effects; Anesthetics, Intravenous - pharmacokinetics; Biochemistry, Molecular Biology; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Critical care; Critical Care Medicine; Critical Illness; Drug dosages; Emergency medical care; Emergency Medicine; Enzymes; Etomidate; Etomidate - adverse effects; Etomidate - pharmacokinetics; Female; Hormones; Humans; Intensive; Intensive care; Intensive care medicine; Intubation; Intubation, Intratracheal; Life Sciences; Linear Models; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Observational studies; Original; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Sepsis; France; Critical care; Adrenal; Corticotropin; Etomidate; Human; Imidazole derivatives; Intensive care; Critically ill; Peptide hormone; Single dose; Etomidate .Adrenal; Adenohypophyseal hormone; General anesthetic; Corticotropin .Critical care; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-007-0970-y

Objective To determine the incidence and duration of adrenal inhibition induced by a single dose of etomidate in critically ill patients. Design Prospective, observational cohort study. Setting Three intensive care units in a university hospital. Patients Forty critically ill patients without sepsis who received a single dose of etomidate for facilitating endotracheal intubation. Measurements and main results Serial serum cortisol and 11β-deoxycortisol samples were taken at baseline and 60 min after corticotropin stimulation test (250 μg 1–24 ACTH) at 12, 24, 48, and 72 h after etomidate administration. Etomidate-related adrenal inhibition was defined by the combination of a rise in cortisol less than 250 nmol/l (9 μg/dl) after ACTH stimulation and an excessive accumulation of serum 11β-deoxycortisol concentrations at baseline. At 12 h after etomidate administration, 32/40 (80%) patients fulfilled the diagnosis criteria for etomidate-related adrenal insufficiency. This incidence was significantly lower at 48 h (9%) and 72 h (7%). The cortisol to 11β-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11β-hydroxylase enzyme blockade, improved significantly over time. Conclusions A single bolus infusion of etomidate resulted in wide adrenal inhibition in critically ill patients. However, this alteration was reversible by 48 h following the drug administration. The empirical use of steroid supplementation for 48 h following a single dose of etomidate in ICU patients without septic shock should thus be considered. Concomitant serum cortisol and 11β-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients.