Duration of adrenal inhibition following a single dose of etomidate in critically ill patients
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...
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Published in | Intensive care medicine Vol. 34; no. 4; pp. 714 - 719 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer-Verlag
01.04.2008
Springer Springer Nature B.V Springer Verlag |
Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0342-4642 1432-1238 |
DOI: | 10.1007/s00134-007-0970-y |