Intensive Care Medicine

, Volume 35, Issue 11, pp 1868–1876

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

  • Brian H. Cuthbertson
  • Charles L. Sprung
  • Djillali Annane
  • Sylvie Chevret
  • Mark Garfield
  • Serge Goodman
  • Pierre-Francois Laterre
  • Jean Louis Vincent
  • Klaus Freivogel
  • Konrad Reinhart
  • Mervyn Singer
  • Didier Payen
  • Yoram G. Weiss
Original

DOI: 10.1007/s00134-009-1603-4

Cite this article as:
Cuthbertson, B.H., Sprung, C.L., Annane, D. et al. Intensive Care Med (2009) 35: 1868. doi:10.1007/s00134-009-1603-4

Abstract

Rationale

Use of etomidate in the critically ill is controversial due to its links with an inadequate response to corticotropin and potential for excess mortality. In a septic shock population, we tested the hypotheses that etomidate administration induces more non-responders to corticotropin and increases mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate.

Methods

An a-priori sub-study of the CORTICUS multi-centre, randomised, double-blind, placebo-controlled trial of hydrocortisone in septic shock. Use and timing of etomidate administration were collected. Endpoints were corticotropin response and all-cause 28-day mortality in patients receiving etomidate.

Measurements and main results

Five hundred patients were recruited, of whom 499 were analysable; 96 (19.2%) were administered etomidate within the 72 h prior to inclusion. The proportion of non-responders to corticotropin was significantly higher in patients who were given etomidate in the 72 h before trial inclusion than in other patients (61.0 vs. 44.6%, P = 0.004). Etomidate therapy was associated with a higher 28-day mortality in univariate analysis (P = 0.02) and after correction for severity of illness (42.7 vs. 30.5%; P = 0.06 and P = 0.03) in our two multi-variant models. Hydrocortisone administration did not change the mortality of patients receiving etomidate (45 vs. 40%).

Conclusions

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 an increase in mortality. We recommend clinicians demonstrate extreme caution in the use of etomidate in critically ill patients with septic shock.

Keywords

Etomidate Relative adrenal insufficiency Septic shock Mortality Hydrocortisone 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Brian H. Cuthbertson
    • 1
  • Charles L. Sprung
    • 2
  • Djillali Annane
    • 3
  • Sylvie Chevret
    • 4
  • Mark Garfield
    • 5
  • Serge Goodman
    • 2
  • Pierre-Francois Laterre
    • 6
  • Jean Louis Vincent
    • 7
  • Klaus Freivogel
    • 8
  • Konrad Reinhart
    • 9
  • Mervyn Singer
    • 10
  • Didier Payen
    • 11
  • Yoram G. Weiss
    • 2
  1. 1.Health Services Research UnitUniversity of AberdeenAberdeenUK
  2. 2.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael
  3. 3.General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP)University of Versailles, SQYGarchesFrance
  4. 4.Biostatistics DepartmentSt Louis HospitalParisFrance
  5. 5.Intensive Care UnitIpswich Hospital NHS TrustIpswichUK
  6. 6.Department of Critical Care MedicineSt Luc University Hospital, UCLBrusselsBelgium
  7. 7.Intensive Care UnitErasme University HospitalBrusselsBelgium
  8. 8.Analytica International GmbH, Untere HerrenstrLörrachGermany
  9. 9.Department of Anaesthesiology and Intensive Care MedicineFriedrich-Schiller UniversitatJenaGermany
  10. 10.Department of Medicine, Wolfson Institute of Biomedical ResearchUniversity College LondonLondonUK
  11. 11.ReanimationHopital LariboisiereParisFrance

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