Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. - Archive ouverte HAL Access content directly
Journal Articles Intensive Care Medicine Year : 2008

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

(1) , (1) , (2, 3) , (1) , (4) , (1) , (5) , (6)
1
2
3
4
5
6

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 11beta-deoxycortisol samples were taken at baseline and 60 min after corticotropin stimulation test (250 microg 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 microg/dl) after ACTH stimulation and an excessive accumulation of serum 11beta-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 11beta-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11beta-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 11beta-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients.
Embargoed file
Embargoed file
Ne sera jamais visible
Loading...

Dates and versions

inserm-00398796 , version 1 (09-06-2011)

Identifiers

Cite

Marc Vinclair, Christophe Broux, Patrice Faure, Julien Brun, Céline Genty, et al.. Duration of adrenal inhibition following a single dose of etomidate in critically ill patients.. Intensive Care Medicine, 2008, 34 (4), pp.714-9. ⟨10.1007/s00134-007-0970-y⟩. ⟨inserm-00398796⟩
899 View
1 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More