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
