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Corticosteroid after etomidate in critically ill patients: a randomized controlled trial.
Jean-Francois Payen1, Clément Dupuis, Thibaut Trouve-Buisson
1Departmentsof Anesthesiology and Critical Care, Albert Michallon Hospital, Grenoble, France. jfpayen@ujf-grenoble.fr
Critical Care Medicine
|September 20, 2011
Summary
Moderate-dose hydrocortisone did not benefit critically ill patients without septic shock experiencing etomidate-induced adrenal insufficiency. This study found no significant improvements in hemodynamic status or outcomes with hydrocortisone treatment.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Pharmacology
Background:
- Etomidate is frequently used for intubation in critically ill patients.
- Etomidate can cause temporary adrenal insufficiency.
- The clinical significance of etomidate-related adrenal insufficiency is debated.
Purpose of the Study:
- To evaluate the impact of moderate-dose hydrocortisone on hemodynamic status.
- To assess the efficacy of hydrocortisone in critically ill patients with etomidate-related adrenal insufficiency.
- To determine if hydrocortisone improves outcomes in this patient population.
Main Methods:
- Randomized, controlled, double-blind trial.
- Patients received either hydrocortisone (200 mg/day) or saline for 42 hours after etomidate administration.
- Hemodynamic status and adrenal function were monitored.
Main Results:
- Etomidate-related adrenal insufficiency was common (91% in HC group, 84% in control group).
- Cardiovascular Sequential Organ Failure Assessment scores declined similarly in both groups.
- Norepinephrine requirements decreased faster in the hydrocortisone group for those initially requiring vasopressors.
Conclusions:
- Moderate-dose hydrocortisone does not appear to benefit critically ill patients without septic shock experiencing etomidate-related adrenal insufficiency.
- The routine use of hydrocortisone to counteract etomidate-induced adrenal insufficiency in this setting may not be warranted.
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