Corticosteroid after etomidate in critically ill patients: a randomized controlled trial.

摘要: Objective: To investigate the effects of moderate-dose hydrocortisone on hemodynamic status in critically ill patients throughout period etomidate-related adrenal insufficiency. Design: Randomized, controlled, double-blind trial (NCT00862381). Setting: University hospital emergency department and three intensive care units. Interventions: After single-dose etomidate (H0) for facilitating endotracheal intubation, without septic shock were randomly allocated at H6 to receive a 42-hr continuous infusion either 200 mg/day (HC group; n 49) or saline serum (control 50). Measurements Main Results: completion corticotrophin stimulation test, cortisol 11-deoxycortisol concentrations subsequently assayed H6, H12, H24, H48. Forty-eight analyzed HC group 49 control group. Before treatment, diagnostic criteria insufficiency fulfilled 41 45 (91%) 38 (84%) groups, respectively. The proportion with cardiovascular Sequential Organ Failure Assessment score 3 4 declined comparably over time both groups: 65% vs. 67% 69% 44% 54% 34% 45% H48, Required doses norepinephrine decreased significantly higher rate compared treated H6. No intergroup differences found regarding duration mechanical ventilation, unit length stay, 28-day mortality. Conclusion: These findings suggest that do not benefit from administered overcome (Crit Care Med 2012; 40:29‐35)