Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. - Inserm - Institut national de la santé et de la recherche médicale Accéder directement au contenu
Article Dans Une Revue Intensive Care Medicine Année : 2008

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

Résumé

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.
Fichier sous embargo
Fichier sous embargo
Date de visibilité indéterminée
Loading...

Dates et versions

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

Identifiants

Citer

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⟩
1496 Consultations
1 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More