Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients

Drug-induced HPA axis alterations during acute critical illness: a multivariable association study

“…Prolonged etomidate infusion during critical illness has been shown to be associated with increased mortality and was therefore abandoned as sedative for patients in ICUs . However, a recent Cochrane review concluded that a single induction dose of etomidate was not associated with an increase in mortality in critical ill patients, although random plasma cortisol concentrations were lowered …”

“…Prior to admission to ICU, surgical as well as medical patients often receive drugs that can theoretically affect the HPA axis, either directly at the hypothalamus–pituitary or adrenocortical level or indirectly via a modulation of the sympathetic nervous system and some are continued during the acute phase of critical illness. Previous studies have shown that anaesthetic drugs, more specifically the hypnotic etomidate, can suppress adrenocortical synthesis of cortisol . However, many other drugs may have HPA suppressive properties as suggested by small interventional studies in surgical and ICU patients, by observational studies of surgical patients and by animal experiments.…”

Etomidat in der Notfallmedizin – Pro und Contra

“…Verschiedene Studien und Metaanalysen untersuchten den Effekt einer Intubationsdosis von Etomidat hinsichtlich Nebenniereninsuffizienz und Outcome. Das Spektrum der Ergebnisse reicht dabei von einem erhöhten Mortalitätsrisiko [15,16], einem vergleichbaren Risiko zu alternativen Einleitungshypnotika [1,8,17,18] bis zu einer verringerten 28-Tage-Mortalität bei septischen Patienten unter Hydrokortisonsubstitution im Vergleich zu alternativen Einleitungshypnotika in einer kleinen Propensity-Score-Analyse [19].…”

Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)

“…Steroidogenesis may be inhibited at various enzymatic steps by drugs, including P-450 aromatase, hydroxysteroid-dehydrogenase, or mitochondrial cytochrome P-450-dependent enzymes (60). In critically ill patients undergoing rapid sequence intubation, the use of etomidate, a drug known to inhibit the last enzymatic step in cortisol synthesis, increased the risk of adrenal insufficiency between 4 to 6 hours (OR 19.98; 95% CI 3.95 to 101.11) and at 12 hours (OR 2.37; 95% CI 1.61 to 3.47) post-dosing (71). This effect was associated with worsening in organ dysfunction but the ultimate effect on mortality remains unclear.…”