Duration of adrenal inhibition following a single dose of etomidate in critically ill patients
Duration of adrenal inhibition following a single dose of etomidate in critically ill patients
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DOI：
10.1007/s00134-007-0970-y
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发表时间：
2008-04-01
影响因子：
38.9
通讯作者：
Payen, Jean-Francois
中科院分区：
文献类型：
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作者：
Vinclair, Marc;Broux, Christophe;Payen, Jean-Francois
目的：确定危重患者单剂量依托咪酯引起的肾上腺抑制的发生率和持续时间。设计：前瞻性、观察性队列研究。地点：大学医院的三个重症监护室。患者：40 名无败血症的危重患者接受单剂量依托咪酯以促进气管插管。测量和主要结果：在依托咪酯给药后 12、24、48 和 72 小时，在基线和促肾上腺皮质激素刺激试验（250 μg 1-24 ACTH）后 60 分钟采集连续血清皮质醇和 11 个 β-脱氧皮质醇样本。依托咪酯相关的肾上腺抑制被定义为ACTH刺激后皮质醇升高低于250 nmol/l (9 μg/dl)和基线时血清11β-脱氧皮质醇浓度过度积累。依托咪酯给药后12小时，32/40（80%）的患者符合依托咪酯相关肾上腺皮质功能不全的诊断标准。该发生率在 48 小时（9%）和 72 小时（7%）时显着降低。皮质醇与 11 β-脱氧皮质醇的比率（F/S 比率）反映了 11 β-羟化酶阻断的强度，随着时间的推移显着改善。结论：单次推注依托咪酯可对危重患者产生广泛的肾上腺抑制作用。然而，这种改变在给药后 48 小时内是可逆的。因此，对于没有脓毒性休克的 ICU 患者，应考虑在单剂量依托咪酯后 48 小时内经验性地补充类固醇。需要同时服用血清皮质醇和 11 β-脱氧皮质醇剂量，以提供依托咪酯在危重患者中诱发肾上腺功能不全的证据。
Objective: To determine the incidence and duration of adrenal inhibition induced by a single dose of etomidate in critically ill patients. Design: Prospective, observational cohort study. Setting: Three intensive care units in a university hospital. Patients: Forty critically ill patients without sepsis who received a single dose of etomidate for facilitating endotracheal intubation. Measurements and main results: Serial serum cortisol and 11 beta-deoxycortisol samples were taken at baseline and 60 min after corticotropin stimulation test (250 mu g 1-24 ACTH) at 12, 24, 48, and 72 h after etomidate administration. Etomidate-related adrenal inhibition was defined by the combination of a rise in cortisol less than 250 nmol/l (9 mu g/dl) after ACTH stimulation and an excessive accumulation of serum 11 beta-deoxycortisol concentrations at baseline. At 12 h after etomidate administration, 32/40 (80%) patients fulfilled the diagnosis criteria for etomidate-related adrenal insufficiency. This incidence was significantly lower at 48 h (9%) and 72 h (7%). The cortisol to 11 beta-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11 beta-hydroxylase enzyme blockade, improved significantly over time. Conclusions: A single bolus infusion of etomidate resulted in wide adrenal inhibition in critically ill patients. However, this alteration was reversible by 48 h following the drug administration. The empirical use of steroid supplementation for 48 h following a single dose of etomidate in ICU patients without septic shock should thus be considered. Concomitant serum cortisol and 11 beta-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients.