Corticosteroid after etomidate in critically ill Patients

A randomized controlled Trial

Jean Francois Payen, Clément Dupuis, Thibaut Trouve-Buisson, Marc Vinclair, Christophe Broux, Pierre Bouzat, Céline Genty, Denis Monneret, Patrice Faure, Olivier Chabre, Jean Luc Bosson

Research output: Contribution to journalArticle

Abstract

Objective: To investigate the effects of moderate-dose hydrocortisone on hemodynamic status in critically ill Patients throughout the period of etomidate-related adrenal insufficiency. Design: Randomized, controlled, double-blind Trial (NCT00862381). Setting: University hospital emergency department and three intensive care units. Interventions: After single-dose etomidate (H0) for facilitating endotracheal intubation, Patients without septic shock were randomly allocated at H6 to receive a 42-hr continuous infusion of either hydrocortisone at 200 mg/day (HC group; n = 49) or saline serum (control group; n = 50). Measurements and Main Results: After completion of a corticotrophin stimulation test, serum cortisol and 11β-deoxycortisol concentrations were subsequently assayed at H6, H12, H24, and H48. Forty-eight Patients were analyzed in the HC group and 49 Patients in the control group. Before treatment, the diagnostic criteria for etomidate-related adrenal insufficiency were fulfilled in 41 of 45 (91%) and 38 of 45 (84%) Patients in the HC and control groups, respectively. The proportion of Patients with a cardiovascular Sequential Organ Failure Assessment score of 3 or 4 declined comparably over time in both HC and control groups: 65% vs. 67% at H6, 65% vs. 69% at H12, 44% vs. 54% at H24, and 34% vs. 45% at H48, respectively. Required doses of norepinephrine decreased at a significantly higher rate in the HC group compared with the control group in Patients treated with norepinephrine at H6. No intergroup differences were found regarding the duration of mechanical ventilation, intensive care unit length of stay, or 28-day mortality. Conclusion: These findings suggest that critically ill Patients without septic shock do not benefit from moderate-dose hydrocortisone administered to overcome etomidate-related adrenal insufficiency.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalCritical Care Medicine
Volume40
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Fingerprint

Etomidate
Critical Illness
Adrenal Cortex Hormones
Randomized Controlled Trials
Adrenal Insufficiency
Hydrocortisone
Control Groups
Septic Shock
Intensive Care Units
Norepinephrine
Cortodoxone
Organ Dysfunction Scores
Intratracheal Intubation
Hospital Departments
Serum
Artificial Respiration
Adrenocorticotropic Hormone
Hospital Emergency Service
Length of Stay
Hemodynamics

Keywords

  • Adrenal insufficiency
  • Critical care
  • Etomidate
  • Outcome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Payen, J. F., Dupuis, C., Trouve-Buisson, T., Vinclair, M., Broux, C., Bouzat, P., ... Bosson, J. L. (2012). Corticosteroid after etomidate in critically ill Patients: A randomized controlled Trial. Critical Care Medicine, 40(1), 29-35. https://doi.org/10.1097/CCM.0b013e31822d7938

Corticosteroid after etomidate in critically ill Patients : A randomized controlled Trial. / Payen, Jean Francois; Dupuis, Clément; Trouve-Buisson, Thibaut; Vinclair, Marc; Broux, Christophe; Bouzat, Pierre; Genty, Céline; Monneret, Denis; Faure, Patrice; Chabre, Olivier; Bosson, Jean Luc.

In: Critical Care Medicine, Vol. 40, No. 1, 01.2012, p. 29-35.

Research output: Contribution to journalArticle

Payen, JF, Dupuis, C, Trouve-Buisson, T, Vinclair, M, Broux, C, Bouzat, P, Genty, C, Monneret, D, Faure, P, Chabre, O & Bosson, JL 2012, 'Corticosteroid after etomidate in critically ill Patients: A randomized controlled Trial', Critical Care Medicine, vol. 40, no. 1, pp. 29-35. https://doi.org/10.1097/CCM.0b013e31822d7938
Payen, Jean Francois ; Dupuis, Clément ; Trouve-Buisson, Thibaut ; Vinclair, Marc ; Broux, Christophe ; Bouzat, Pierre ; Genty, Céline ; Monneret, Denis ; Faure, Patrice ; Chabre, Olivier ; Bosson, Jean Luc. / Corticosteroid after etomidate in critically ill Patients : A randomized controlled Trial. In: Critical Care Medicine. 2012 ; Vol. 40, No. 1. pp. 29-35.
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AU - Broux, Christophe

AU - Bouzat, Pierre

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