Adrenal suppression following a single dose of etomidate for rapid sequence induction: A prospective randomized study
Adrenal suppression following a single dose of etomidate for rapid sequence induction: A prospective randomized study
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DOI：
10.1097/ta.0b013e31818255e8
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发表时间：
2008-09-01
影响因子：
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通讯作者：
Barker, Donald E.
中科院分区：
文献类型：
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作者：
Hildreth, Amy N.;Mejia, Vicente A.;Barker, Donald E.
背景：使用依托咪酯进行快速序列诱导（RSI）与非创伤患者随后的肾上腺皮质功能不全有关。然而，依托咪酯相关的肾上腺皮质功能不全在创伤人群中尚未得到充分研究。目的：我们进行了一项前瞻性、随机、对照研究，以评估一剂依托咪酯治疗 RSI 对肾上腺功能的影响及其在创伤患者复苏期间和复苏后的临床意义。方法：将入住我们一级创伤中心需要 RSI 的成人创伤患者随机分组接受治疗 依托咪酯0.3mg/kg、琥珀胆碱1mg/kg(E组)或芬太尼100μg、咪达唑仑5mg、琥珀胆碱1mg/kg(FM组)诱导。在 RSI 之前绘制基线血清皮质醇水平。 RSI 后四到六小时，绘制插管后血清皮质醇水平。进行ACTH刺激试验。结果：纳入30名患者：E组患者18名，FM组患者12名。两组之间在年龄、损伤严重程度评分和基线血清皮质醇方面没有检测到统计学差异。插管后 4 至 6 小时，E 组患者的平均血清皮质醇水平显着低于 FM 组患者（18.2 vs. 27.8 μg/dL，p < 0.05）。基线和插管后水平之间血清皮质醇的变化不同（-12.8 μg/dL +/- 9.6 μg/dL vs. 1.1 μg/dL +/- 7.6 μg/dL，p < 0.01）。 E组患者在给予ACTH后皮质醇平均增加4.2μg/dL+/-4.9μg/dL，而FM组患者皮质醇平均增加11.2μg/dL+/-6.1μg/dL，p<0.001。 E 组患者需要更长的 ICU 住院时间（平均 6.3 天与 1.5 天，p < 0.05）、更多的呼吸机天数（平均 28 天与 17 天，p < 0.01）以及更长的住院时间（平均 11.6 天与 6.4 天，p < 0.01）。结论：。在创伤患者中使用依托咪酯治疗 RSI 会导致肾上腺皮质功能不全的化学证据，并可能导致住院和 ICU 住院时间增加以及呼吸机天数增加。应考虑进一步研究来评估该药物在创伤患者中的安全性。
Background: The administration of etomidate for rapid sequence induction (RSI) has been linked to subsequent adrenocortical insufficiency in nontrauma patients. However, etomidate-related adrenocortical insufficiency has not been well studied in the trauma population.Purpose: We performed a prospective, randomized, controlled study to assess the effect of one dose of etomidate for RSI on adrenal function and its clinical significance during and after resuscitation in trauma patients.Methods: Adult trauma patients admitted to our Level I trauma center requiring RSI were randomized to receive etomidate 0.3 mg/kg and succinylcholine 1 mg/kg (E group) or fentanyl 100 mu g, midazolam 5 mg, and succinylcholine 1 mg/kg (FM group) for induction. A baseline serum cortisol level was drawn before RSI. Four to six hours after RSI, a postintubation serum cortisol level was drawn. An ACTH stimulation test was performed.Results: Thirty 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, and baseline serum cortisol. Mean serum cortisol levels were significantly lower in E group patients than in FM group patients 4 to 6 hours after intubation (18.2 vs. 27.8 mu g/dL, p < 0.05). Change in serum cortisol between baseline and postintubation levels was different (-12.8 mu g/dL +/- 9.6 mu g/dL vs. 1.1 mu g/dL +/- 7.6 mu g/dL, p < 0.01). Patients in the E group had an average increase in cortisol after ACTH administration of 4.2 mu g/dL +/- 4.9 mu g/dL vs. 11.2 mu g/dL +/- 6.1 mu g/dL in the FM group, p < 0.001. Patients in the E group required longer ICU lengths of stay (mean, 6.3 days vs. 1.5 days, p < 0.05), more ventilator days (mean, 28 days vs. 17 days, p < 0.01), and longer hospital lengths of stay (mean, 11.6 days vs. 6.4 days, p < 0.01).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.