Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients

Abstract

Background: Timely diagnosis and treatment of adrenal insufficiency (AI) dramatically reduces mortality in trauma patients. We sought to identify risk factors and populations with a high risk of developing AI.

The effect of etomidate on adrenal function in critical illness: a systematic review

“…The absolute risk of AI associated with versus without etomidate was 69 versus 17% (''pc'' D. Annane, P \ 0.001, Table 1). Adrenal insufficiency in the ICU was greater with etomidate than comparators in the studies of: Mohammed [23] (n = 152, septic shock, 76 vs. 51%, P = 0.008); Kim [24] (n = 65, septic shock, 84 vs. 48%, P = 0.003); Cotton [25] (n = 137, trauma patients, 68 vs. 48%, P = 0.02); Malerba [26] (n = 62, mechanical ventilation for [24 h, 68 vs. 24%, P = 0.001); and Cohan [27] (n = 79, traumatic brain injury, 60 vs. 33%, P = 0.049 by univariate but not multivariate analysis). AI was not increased with etomidate versus comparators in: De Jong [28] (n = 405, prolonged hypotension, 60 vs. 57%, ''pc'' M.F.C.…”

“…); Mohammed[23] (n = 152, 63 vs. 55%); Kim[24] (n = 65, 32 vs. 43%); Cotton[25] (n = 137, 18 vs. 26%, ''pc'' B.A. Cotton); De Jong [28] (n = 405, 17 vs. 23%, ''pc'' De Jong); Riche [29] (n = 116, 36 vs. 47%) ''pc'' F. Riche); Den Brinker [30, 31] (n = 31, 30 vs. 12.5%); Ray and McKeown [33] (n = 159, ICU with septic shock, 69 vs. 60%); or Tekwani [34] (n = 106, ICU with sepsis, 38 vs. 44%).…”

Induction drug and outcome of patients admitted to the intensive care unit after emergency laparotomy

“…Certainly, etomidate impairs cortisol response to corticotrophin in critically ill patients. [28][29][30][31][32][33] However, corticotrophin stimulation tests are unreliable in critical illness, 12 and the clinical consequences of such suppression are not clear. 5,9,[13][14][15][16][17][18][19]26 We found that etomidate was chosen more frequently than thiopental or propofol for sicker patients.…”

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

“…Etomidat, als Einmaldosis bei Narkoseeinleitung, wurde als einer der wenigen modifizierbaren Risikofaktoren für die Entwicklung einer Nebennierenrindeninsuffizienz bei kritisch kranken Traumapatienten identifiziert [22]. Etomidat war mit einem erhöhten Risiko für ein "acute respiratory distress syndrome" (ARDS) bzw.…”