title: Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*.
abstract: OBJECTIVE
  To evaluate the effects of single-dose etomidate on the adrenal axis and mortality in patients with severe sepsis and septic shock.
  
  
  METHODS
  A systematic review of randomized controlled trials and observational studies with meta-analysis.
  
  
  METHODS
  Literature search of EMBASE, Medline, Cochrane Database, and Evidence-Based Medical Reviews.
  
  
  METHODS
  Sepsis patients who received etomidate for rapid sequence intubation.
  
  
  METHODS
  None.
  
  
  RESULTS
  We conducted a systematic review of randomized controlled trials and observational studies with meta-analysis assessing the effects of etomidate on adrenal insufficiency and all-cause mortality published between January 1950 and February 2012. We only examined studies including septic patients. All-cause mortality served as our primary end point, whereas the prevalence of adrenal insufficiency was our secondary end point. Adrenal insufficiency was determined using a cosyntropin stimulation test in all studies. We used a random effects model for analysis; heterogeneity was assessed with the I statistic. Publication bias was evaluated with Begg's test. Five studies were identified that assessed mortality in those who received etomidate. A total of 865 subjects were included. Subjects who received etomidate were more likely to die (pooled relative risk 1.20; 95% confidence interval 1.02-1.42; Q statistic, 4.20; I2 statistic, 4.9%). Seven studies addressed the development of adrenal suppression associated with the administration of etomidate; 1,303 subjects were included. Etomidate administration increased the likelihood of developing adrenal insufficiency (pooled relative risk 1.33; 95% confidence interval 1.22-1.46; Q statistic, 10.7; I2 statistic, 43.9%).
  
  
  CONCLUSIONS
  Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis.
authors.affiliation: Pulmonary & Critical Care Medicine, Washington Hospital Center, Washington, DC, USA. chee262@hotmail.com
authors.forename: Chee Man
authors.initials: CM
authors.lastname: Chan
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Mitchell
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000150:complications* / Q000401:mortality*
chemical_list: D018686:Anesthetics, Intravenous; D005045:Etomidate