Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis

@article{JCherfan2012AdvantagesAD,
  title={Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis},
  author={Antoine J. Cherfan and Yaseen M. Arabi and Hasan M. Al-Dorzi and Lisa P. Kenny},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  year={2012},
  volume={32}
}
Etomidate is a potent imidazole hypnotic used widely in single doses in the rapid sequence intubation of critically ill patients with sepsis due to its presumed hemodynamic safety, fast onset, and short duration of action. However, the literature is conflicting regarding the hemodynamic advantages of etomidate over other induction agents, and its safety in this population is a matter of strong debate in the critical care community as the drug is associated with suppression of adrenal… 

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References

SHOWING 1-10 OF 43 REFERENCES

A review of etomidate for rapid sequence intubation in the emergency department.

TLDR
Etomidate is cerebroprotective, with the ability to decrease intracranial pressure and maintain cerebral perfusion, making it an ideal agent for patients with head injuries and should be adopted for RSI in specific ED patient groups.

The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock

TLDR
The use of bolus dose etomidate in the 72 h before study inclusion is associated with an increased incidence of inadequate response to corticotropin, but is also likely to be associated with a increase in mortality.

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

TLDR
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, and 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.

Controversies Surrounding the Use of Etomidate for Rapid Sequence Intubation in Patients with Suspected Sepsis

TLDR
Until further studies are available, etomidate should be reserved for hemodynamically unstable patients who cannot tolerate an alternative induction agent despite the administration of fluids or vasoactive agents.

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

TLDR
There is an increased rate of AI and mortality in critically ill patients who received etomidate and non-etomidate anesthesia, and this results in an increased risk ratio (RR) for AI.

The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate

TLDR
The incidence of relative adrenal insufficiency in patients with septic shock is increased when the stimulation test is performed after the administration of etomidate.

Adrenal suppression following a single dose of etomidate for rapid sequence induction: a prospective randomized study.

TLDR
The use of etomidate for RSI in trauma patients led to chemical evidence of adrenocortical insufficiency and may have contributed to increased hospital and ICU lengths of stay and increased ventilator days.

Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock

TLDR
Etomidate use for critically ill patients should consider all of these issues and not simply the possibility of adrenal suppression, which may not be important when steroid supplements are used.