Should etomidate be used for rapid-sequence intubation induction in critically ill septic patients?

摘要: Etomidate is an agent often used by emergency medicine physicians for rapid-sequence intubation induction of critically ill patients because its reliable pharmacokinetics and cardiovascular stability. known to inhibit endogenous cortisol production through inhibition 11β-hydroxylase. Previous studies in undifferentiated department healthy, elective surgical have shown this effect be only transient not clinically significant. Recent retrospective the pediatric adult intensive care literature association between a single dose etomidate septic sustained suppression adrenal axis with increase mortality. It unknown at time if any mortality associated etomidate-induced would offset concomitant corticosteroid administration. Aggressive resuscitation fluids, antibiotics, vasopressors has been significantly reduce may allow use alternative agents that had previously discouraged concern hemodynamic collapse during intubation. A prospective randomized trial early corticotropin stimulation testing or supplementation vs enough power detect differences needed further address clinical dilemma.