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01-04-2008 | Original

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients

Authors: Marc Vinclair, Christophe Broux, Patrice Faure, Julien Brun, Céline Genty, Claude Jacquot, Olivier Chabre, Jean-François Payen

Published in: Intensive Care Medicine | Issue 4/2008

Abstract

Objective

To determine the incidence and duration of adrenal inhibition induced by a single dose of etomidate in critically ill patients.

Design

Prospective, observational cohort study.

Setting

Three intensive care units in a university hospital.

Patients

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

Measurements and main results

Serial serum cortisol and 11β-deoxycortisol samples were taken at baseline and 60 min after corticotropin stimulation test (250 μg 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 μg/dl) after ACTH stimulation and an excessive accumulation of serum 11β-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 11β-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11β-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 11β-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients.

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Title: Duration of adrenal inhibition following a single dose of etomidate in critically ill patients
Authors: Marc Vinclair
Christophe Broux
Patrice Faure
Julien Brun
Céline Genty
Claude Jacquot
Olivier Chabre
Jean-François Payen
Publication date: 01-04-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0970-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients

Abstract

Objective

Design

Setting

Patients

Measurements and main results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Measurements and main results

Conclusions

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