trauma-list Digest, Vol 50, Issue 5

[Kashuk, Jeffry]

Abstract scheduled for presentation at AAST in September....


ADRENAL INSUFFICIENCY FOLLOWING A SINGLE DOSE OF
ETOMIDATE FOR RAPID SEQUENCE INDUCTION: A PROSPECTIVE
RANDOMIZED STUDY
AN Hildreth, MD; VA Mejia, MD, RA Maxwell, MD*; PW Smith, MD; BW Dart, MD; DE
Barker*, MD
Introduction: The administration of etomidate for rapid sequence induction (RSI) has been
linked to subsequent adrenocortical insufficiency in non-trauma patients. However,
etomidate- related adrenocortical insufficiency has not been well studied in the trauma
population.
Purpose: We performed a prospective, randomized, controlled study to determine the
incidence of adrenocortical insufficiency and its significance during the first 24 hours of
resuscitation following RSI in trauma patients.
Methods: Adult trauma patients admitted to our Level I trauma center requiring RSI were
randomized to receive either etomidate 0.3mg/kg and succinylcholine 1mg/kg (E group) or
fentanyl 100 μg, midazolam 5mg, and succinylcholine 1mg/kg (FM group) for induction.
A baseline serum cortisol level was drawn prior to RSI. Four to six hours after RSI a
second serum cortisol level was drawn. A cortrosyn stimulation test (CST) was performed.
Results: 30 patients were enrolled: 18 E group patients and 12 FM group patients. No
statistical difference was detected between the two groups with respect to age, injury
severity score (ISS), and baseline serum cortisol. Mean serum cortisol levels were
significantly lower in E group patients than in FM group patients four to six hours after
intubation (18.2 vs. 27.8μg/dL, p<0.05). A normal response to CST (increase >9μg/dL or
baseline >34μg/dL) occurred in 100% of FM group patients vs. 5.9% of E group patients
(p<0.05). Patients in the E group required longer ICU lengths of stay (mean 6.3 vs. 1.5
days, p<0.05), more ventilator days (mean 28 vs. 17 days, p<0.05), and longer hospital
lengths of stay (mean 11.6 vs. 6.4 days, p<0.05).
Conclusions: The use of etomidate for RSI in trauma patients led to chemical evidence of
adrenocortical insufficiency and may have contributed to increased hospital and ICU
lengths of stay and increased ventilator days. Further studies should be considered to
evaluate the safety profile of this drug in trauma patients. 

-----Original Message-----
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Sent: Friday,August 03,2007 5:01 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 50, Issue 5

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