Association between Etomidate Use for Rapid Sequence Intubation and Adrenal Insufficiency in Sepsis

Area of Science:

• Critical Care Medicine
• Pharmacology
• Endocrinology

Background:

• The use of etomidate for rapid sequence intubation (RSI) in patients with sepsis is controversial regarding the risk of adrenal insufficiency (AI).
• Understanding the prevalence and risk factors for AI following etomidate administration is crucial for patient management.

Purpose of the Study:

• To assess the prevalence of AI in surgical intensive care unit (SICU) patients undergoing RSI with etomidate.
• To identify risk factors associated with AI development in this patient population.

Main Methods:

• Retrospective study utilizing prospectively acquired data from SICU patients.
• Evaluation of patients who received etomidate for RSI and subsequent development of AI.
• Comparison of AI incidence between patients who received etomidate and those who did not, and analysis of risk factors including septic shock.

Main Results:

• Of 44 adult SICU patients, 34 received etomidate for RSI. Overall, 54.55% developed AI, and 59.09% had septic shock.
• No statistically significant difference in AI incidence was observed between patients who received etomidate (47%) and those who did not (80%).
• A non-significant trend (p=0.06) indicated a higher incidence of AI in septic patients who received etomidate compared to non-septic patients.

Conclusions:

• A single dose of etomidate for RSI in SICU patients is not associated with increased AI or mortality.
• A trend suggests a potential link between sepsis and AI development in patients receiving etomidate.
• Further high-quality, adequately powered randomized controlled trials are needed to definitively establish the relationship between etomidate, sepsis, and AI.