Abstract
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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Acknowledgements
The authors thank Marie-Joseph Valley for her assistance with the 11β-deoxycortisol measurements.
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Financial support: All of the authors have disclosed that they have no financial relationship with or interest in any commercial companies.
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Vinclair, M., Broux, C., Faure, P. et al. Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. Intensive Care Med 34, 714–719 (2008). https://doi.org/10.1007/s00134-007-0970-y
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DOI: https://doi.org/10.1007/s00134-007-0970-y