trauma-list Digest, Vol 50, Issue 5

[IVAN HRONEK]

Jeffrey,
 
here's a response to your abstract (which was a study in trauma patients showing adrenocortical insufficiency after Etomidate).
 
Attached is a paper agreeing on that with you, but finding it does not reflect in the outcome (this is in septic shock).
 
Like they say at the end of your abstract - further studies are needed, but until then, I believe it probably does not reflect in the outcomeor, as I showed in the previous email, you can co-administer Hydrocortisonse with Etomidate if you prefer.
Ivan 



> Date: Fri, 3 Aug 2007 07:02:48 -0600> From: Jeffry.Kashuk at dhha.org> To: trauma-list at trauma.org> Subject: RE: trauma-list Digest, Vol 50, Issue 5> > > 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-----> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of trauma-list-request at trauma.org> Sent: Friday,August 03,2007 5:01 AM> To: trauma-list at trauma.org> Subject: trauma-list Digest, Vol 50, Issue 5> > Send trauma-list mailing list submissions to> trauma-list at trauma.org> > To subscribe or unsubscribe via the World Wide Web, visit> http://list.mistral.net/mailman/listinfo/trauma-list> or, via email, send a message with subject or body 'help' to> trauma-list-request at trauma.org> > You can reach the person managing the list at> trauma-list-owner at trauma.org> > When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..."> > > ------------------------------------------------------------------------------> CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner. Thank you.> > ==============================================================================> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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