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Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation

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Abstract

Objective

To study the factors associated with relative adrenocortical deficiency in mechanically ventilated, critically ill patients

Design and setting

Prospective observational study in a multidisciplinary ICU of a university-affiliated teaching hospital

Patients

Sixty-two consecutive, acutely ill patients needing mechanical ventilation for more than 24 h.

Measurements and results

A high-dose short corticotropin test 24 h after endotracheal intubation. Relative adrenocortical deficiency (“nonresponder” group of patients) was defined by a rise in cortisol less than 90 µg/l after stimulation. Twenty-seven patients were classified as nonresponders and 35 as responders. On univariate analysis nonresponders were more often men, had lower mean arterial pressure, required vasoactive agents more often, had lower creatinine clearance, higher SAPS II, higher organ dysfunction scores, and received etomidate as a single bolus for endotracheal intubation more often than responders. On multivariate analysis, only etomidate administration was related to relative adrenocortical deficiency (OR 12.21; 95% CI 2.99–49.74) while female gender was protective (OR 0.13; 95% CI 0.03–0.57).

Conclusions

A single bolus infusion of etomidate could be a major risk factor for the development of relative adrenocortical deficiency in ICU patients for at least 24 h after administration. Female gender is an independent protective factor.

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Author information

Authors and Affiliations

  1. Service d’aide médicale urgente, Centre Hospitalier Universitaire, 54035, Nancy Cedex, France

    Gabriel Malerba & Lionel Nace

  2. Service de Réanimation Médicale, Centre Hospitalier Universitaire, 54035, Nancy Cedex, France

    Aurélie Cravoisy, Bruno Lévy & Pierre-Edouard Bollaert

  3. Service d’Epidémiologie et Evaluation Clinique, Centre Hospitalier Universitaire, 54035, Nancy Cedex, France

    Florence Romano-Girard

  4. Laboratoire de Biochimie, Centre Hospitalier Universitaire, 54035, Nancy Cedex, France

    Brigitte Dousset

Authors
  1. Gabriel Malerba
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  2. Florence Romano-Girard
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  3. Aurélie Cravoisy
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  4. Brigitte Dousset
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  5. Lionel Nace
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  6. Bruno Lévy
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  7. Pierre-Edouard Bollaert
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Corresponding author

Correspondence to Pierre-Edouard Bollaert.

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Malerba, G., Romano-Girard, F., Cravoisy, A. et al. Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation. Intensive Care Med 31, 388–392 (2005). https://doi.org/10.1007/s00134-004-2550-8

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  • DOI: https://doi.org/10.1007/s00134-004-2550-8

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