title: Relative adrenal insufficiency in critically ill patient after rapid sequence intubation: KETASED ancillary study.
abstract: OBJECTIVE
  Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI.
  
  
  METHODS
  A prespecified ancillary study of KETASED, a randomized prospective multicenter trial, was conducted. Three hundred ten patients who underwent RSI in an out-of-hospital setting had baseline cortisol and adrenocorticotropic hormone response test measurements within 24 hours of intensive care unit admission and were included.
  
  
  RESULTS
  The mean (SD) age was 55 (19) years, with a mean (SD) Sequential Organ Failure Assessment score of 9 (4). Two hundred forty-seven (69%) patients presented with RAI. Baseline characteristics were similar between patients with and without RAI, except for the use of etomidate as a sedative agent (63% of patients with RAI vs 21%, P<.001), and history of chronic kidney disease. There was no difference in terms of 28-day mortality between the 2 groups (21% vs 19%, P=.65) and in terms of other 28-day prognosis end points.
  
  
  CONCLUSIONS
  In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.
authors: Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France; Université Pierre et Marie Curie Paris 6 (Sorbonne Université), Paris, France. Electronic address: yonathanfreund@gmail.com.
authors: Yonathan
authors: Y
authors: Freund
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France; SAMU de Paris, Hôpital Necker-Enfants Malades, APHP, Paris, France; INSERM Unité 970, Centre de Recherche Cardiovasculaire de Paris, Université Paris Descartes, Paris, France.
authors: Patricia
authors: P
authors: Jabre
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.
authors: Jerome
authors: J
authors: Mourad
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.
authors: Frederic
authors: F
authors: Lapostolle
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.
authors: Paul-Georges
authors: PG
authors: Reuter
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.
authors: Maguy
authors: M
authors: Woimant
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.
authors: Nicolas
authors: N
authors: Javaud
authors: Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.
authors: Frederic
authors: F
authors: Adnet
mesh_terms: D000311:Adrenal Glands / Q000503:physiopathology; D000309:Adrenal Insufficiency / Q000097:blood / Q000150:complications / Q000401:mortality*; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D004632:Emergency Medical Services; D005045:Etomidate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007362:Intensive Care Units; D007440:Intubation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D006993:Hypnotics and Sedatives; D006854:Hydrocortisone; D005045:Etomidate
keywords: Adrenal insufficiency; Etomidate; RSI