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.


METHODS
Prospective, observational cohort study.


METHODS
Three intensive care units in a university hospital.


METHODS
Forty critically ill patients without sepsis who received a single dose of etomidate for facilitating endotracheal intubation.


RESULTS
Serial serum cortisol and 11beta-deoxycortisol samples were taken at baseline and 60 min after corticotropin stimulation test (250 microg 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 microg/dl) after ACTH stimulation and an excessive accumulation of serum 11beta-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 11beta-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11beta-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 11beta-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients.
Vinclair
Marc
M
Department of Anesthesiology and Critical Care, Albert Michallon Hospital, BP 217, 38043, Grenoble, France.
Broux
Christophe
C
Faure
Patrice
P
Brun
Julien
J
Genty
Céline
C
Jacquot
Claude
C
Chabre
Olivier
O
Payen
Jean-François
JF
D000304:Adrenal Cortex Function Tests; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000009:adverse effects* / Q000493:pharmacokinetics; D016638:Critical Illness; D005045:Etomidate / Q000009:adverse effects* / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D005045:Etomidate