Etomidate, sepsis, and adrenal function: not as bad as we thought?
The choice of induction agent for endotracheal intubation can have significant downstream effects, especially in critically ill patients. In a retrospective study, Ray and McKeown found that the choice of induction agent had no significant effect on use of vasoactive medications, corticosteroids, or mortality. Given the heated debate regarding corticosteroids in septic shock and the role that etomidate may play in leading to adrenal insufficiency, enthusiasm for etomidate as an induction agent should be tempered by its possible, significant side effects in these critically ill patients.
Kamp
Ryan
R
University of Chicago Hospitals, S Maryland Avenue, Chicago, Illinois 60637, USA.
Kress
John P
JP
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000311:Adrenal Glands / Q000187:drug effects*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D016638:Critical Illness; D005045:Etomidate / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D018805:Sepsis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018686:Anesthetics, Intravenous; D006854:Hydrocortisone; D005045:Etomidate