Corticosteroids Impart No Benefit After Single-Dose Etomidate for Intubation

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Corticosteroids Impart No Benefit After Single-Dose Etomidate for Intubation

Moderate-dose hydrocortisone infusion did not affect outcomes in intubated patients without septic shock who had etomidate-related adrenal insufficiency.

Some physicians have expressed concern about adrenal suppression associated with etomidate use, but is this suppression clinically relevant? Researchers in France prospectively studied 97 patients with acute medical or traumatic conditions without septic shock who underwent intubation with etomidate plus succinylcholine in the prehospital or emergency department settings. Patients were randomized to receive continuous infusions of hydrocortisone (200 mg/day) or saline for 42 hours, starting 6 hours after intubation. Postintubation sedation was maintained with a variety of sedative and analgesic agents (not etomidate). Patients received vasopressor support and insulin as required to maintain target mean arterial blood pressure of 65 to 90 mm Hg and serum glucose levels of <10 mmol/L.

Six hours after etomidate administration, 91% of patients randomized to the hydrocortisone group and 84% randomized to the control group met criteria for adrenal insufficiency based on corticotrophin stimulation tests and serum hormonal assays. No significant differences were noted between groups in rate of decline of Sequential Organ Failure Assessment scores, duration of mechanical ventilation, length of stay in the intensive care unit, or 28-day mortality.

Comment: Hydrocortisone treatment is not without risk and does not seem to benefit the group of patients studied. Etomidate, with its stable cardiovascular profile, remains an induction agent of choice for emergency intubation, particularly in multitrauma patients with brain injury whose outcomes might be worsened by inadequate systemic blood pressure for cerebral perfusion.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine January 13, 2012

Citation(s):

Payen JF et al. Corticosteroid after etomidate in critically ill patients: A randomized controlled trial. Crit Care Med 2012 Jan; 40:29.

Medline abstract (Free)

Marik PE. Etomidate in critically ill patients: Is it safe? Crit Care Med 2012 Jan; 40:301.

Medline abstract (Free)

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