Thursday January 31, 2008
Etomidate controversy continues !!

Use of Etomidate in intubation remained controversial due to its ability to cause adrenal insufficiency (AI) but still commonly used due to its excellent hemodynamic profile !

See this recent retrospective registry study published in Archives of surgery 1: Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients

Interventions: Cosyntropin stimulation testing (CST), in which response was defined as an increase of 9 µg/dL (248 nmol/L) or more in cortisol level.

Results: In 137 patients, CST was performed; 83 (60.6%) were nonresponders and 54 (39.4%) were responders.

3 independent factors in non-responders were

• Rates of hemorrhagic shock on admission
• requirement of vasopressor support and
• etomidate exposure

Age, sex, race, trauma mechanism, injury severity score, and revised trauma score were not statistically different between the groups. Rates of sepsis/septic shock, mechanical ventilation, and mortality were also similar between the 2 groups.


Conclusions: Exposure to etomidate is a modifiable risk factor for the development of AI in this sample of critically injured patients.




Reference: click to get abstract / article if available

1. Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients - Arch Surg. 2008;143(1):62-67