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

Marc Vinclair, Christophe Broux, Patrice Faure, Julien Brun, Céline Genty, Claude Jacquot, Olivier Chabre, Jean François Payen

Research output: Contribution to journalArticle

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

Original languageEnglish (US)
Pages (from-to)714-719
Number of pages6
JournalIntensive Care Medicine
Volume34
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Etomidate
Critical Illness
Cortodoxone
Hydrocortisone
Adrenal Insufficiency
Adrenocorticotropic Hormone
Serum
Cosyntropin
Intratracheal Intubation
Incidence
Septic Shock
Mixed Function Oxygenases
Observational Studies
Intensive Care Units
Sepsis
Cohort Studies
Steroids

Keywords

  • Adrenal
  • Corticotropin
  • Critical care
  • Etomidate

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Vinclair, M., Broux, C., Faure, P., Brun, J., Genty, C., Jacquot, C., ... Payen, J. F. (2008). Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. Intensive Care Medicine, 34(4), 714-719. https://doi.org/10.1007/s00134-007-0970-y

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. / Vinclair, Marc; Broux, Christophe; Faure, Patrice; Brun, Julien; Genty, Céline; Jacquot, Claude; Chabre, Olivier; Payen, Jean François.

In: Intensive Care Medicine, Vol. 34, No. 4, 04.2008, p. 714-719.

Research output: Contribution to journalArticle

Vinclair, M, Broux, C, Faure, P, Brun, J, Genty, C, Jacquot, C, Chabre, O & Payen, JF 2008, 'Duration of adrenal inhibition following a single dose of etomidate in critically ill patients', Intensive Care Medicine, vol. 34, no. 4, pp. 714-719. https://doi.org/10.1007/s00134-007-0970-y
Vinclair, Marc ; Broux, Christophe ; Faure, Patrice ; Brun, Julien ; Genty, Céline ; Jacquot, Claude ; Chabre, Olivier ; Payen, Jean François. / Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. In: Intensive Care Medicine. 2008 ; Vol. 34, No. 4. pp. 714-719.
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