Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*. [Review] 

 -  2012 
<br/><br/>Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006 
<br/><br/> CONCLUSIONS: Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis.  DESIGN: A systematic review of randomized controlled trials and observational studies with meta-analysis.  INTERVENTIONS: None.  MEASUREMENTS AND MAIN RESULTS: We conducted a systematic review of randomized controlled trials and observational studies with meta-analysis assessing the effects of etomidate on adrenal insufficiency and all-cause mortality published between January 1950 and February 2012. We only examined studies including septic patients. All-cause mortality served as our primary end point, whereas the prevalence of adrenal insufficiency was our secondary end point. Adrenal insufficiency was determined using a cosyntropin stimulation test in all studies. We used a random effects model for analysis; heterogeneity was assessed with the I statistic. Publication bias was evaluated with Begg's test. Five studies were identified that assessed mortality in those who received etomidate. A total of 865 subjects were included. Subjects who received etomidate were more likely to die (pooled relative risk 1.20; 95% confidence interval 1.02-1.42; Q statistic, 4.20; I2 statistic, 4.9%). Seven studies addressed the development of adrenal suppression associated with the administration of etomidate; 1,303 subjects were included. Etomidate administration increased the likelihood of developing adrenal insufficiency (pooled relative risk 1.33; 95% confidence interval 1.22-1.46; Q statistic, 10.7; I2 statistic, 43.9%).  OBJECTIVE: To evaluate the effects of single-dose etomidate on the adrenal axis and mortality in patients with severe sepsis and septic shock.  SETTING: Literature search of EMBASE, Medline, Cochrane Database, and Evidence-Based Medical Reviews.  SUBJECTS: Sepsis patients who received etomidate for rapid sequence intubation. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0090-3493 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Adrenal Insufficiency/ci [Chemically Induced]<br/>*Anesthetics, Intravenous/ae [Adverse Effects]<br/>*Etomidate/ae [Adverse Effects]<br/>*Sepsis/co [Complications]<br/>*Sepsis/mo [Mortality]<br/>Aged<br/>Aged, 80 and over<br/>Female<br/>Humans<br/>Male<br/>Middle Aged<br/>Qualitative Research<br/>Randomized Controlled Trials as Topic
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Medicine/Pulmonary-Critical Care
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Meta-Analysis<br/>Review