title: Corticosteroid after etomidate in critically ill patients: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate the effects of moderate-dose hydrocortisone on hemodynamic status in critically ill patients throughout the period of etomidate-related adrenal insufficiency.
  
  
  METHODS
  : Randomized, controlled, double-blind trial (NCT00862381).
  
  
  METHODS
  University hospital emergency department and three intensive care units.
  
  
  METHODS
  After single-dose etomidate (H0) for facilitating endotracheal intubation, patients without septic shock were randomly allocated at H6 to receive a 42-hr continuous infusion of either hydrocortisone at 200 mg/day (HC group; n = 49) or saline serum (control group; n = 50).
  
  
  RESULTS
  After completion of a corticotrophin stimulation test, serum cortisol and 11β-deoxycortisol concentrations were subsequently assayed at H6, H12, H24, and H48. Forty-eight patients were analyzed in the HC group and 49 patients in the control group. Before treatment, the diagnostic criteria for etomidate-related adrenal insufficiency were fulfilled in 41 of 45 (91%) and 38 of 45 (84%) patients in the HC and control groups, respectively. The proportion of patients with a cardiovascular Sequential Organ Failure Assessment score of 3 or 4 declined comparably over time in both HC and control groups: 65% vs. 67% at H6, 65% vs. 69% at H12, 44% vs. 54% at H24, and 34% vs. 45% at H48, respectively. Required doses of norepinephrine decreased at a significantly higher rate in the HC group compared with the control group in patients treated with norepinephrine at H6. No intergroup differences were found regarding the duration of mechanical ventilation, intensive care unit length of stay, or 28-day mortality.
  
  
  CONCLUSIONS
  These findings suggest that critically ill patients without septic shock do not benefit from moderate-dose hydrocortisone administered to overcome etomidate-related adrenal insufficiency.
authors.affiliation: Departmentsof Anesthesiology and Critical Care, Albert Michallon Hospital, Grenoble, France. jfpayen@ujf-grenoble.fr
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Payen
authors.forename: Clément
authors.initials: C
authors.lastname: Dupuis
authors.forename: Thibaut
authors.initials: T
authors.lastname: Trouve-Buisson
authors.forename: Marc
authors.initials: M
authors.lastname: Vinclair
authors.forename: Christophe
authors.initials: C
authors.lastname: Broux
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.forename: Céline
authors.initials: C
authors.lastname: Genty
authors.forename: Denis
authors.initials: D
authors.lastname: Monneret
authors.forename: Patrice
authors.initials: P
authors.lastname: Faure
authors.forename: Olivier
authors.initials: O
authors.lastname: Chabre
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D000328:Adult; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D016638:Critical Illness / Q000628:therapy*; D004311:Double-Blind Method; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D006854:Hydrocortisone; D005045:Etomidate