000			03709nam a22005657a 4500
008			130917s20122012 xxu||||| |||| 00| 0 eng dOvid Technologies
022			_a0090-3493
040			_aOvid MEDLINE(R)
099			_a22971586
245			_aEtomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*. [Review]
251			_aCritical Care Medicine. 40(11):2945-53, 2012 Nov.
252			_aCrit Care Med. 40(11):2945-53, 2012 Nov.
253			_aCritical care medicine
260			_c2012
260			_fFY2013
266			_d2013-09-17
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
520			_aCONCLUSIONS: Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis.
520			_aDESIGN: A systematic review of randomized controlled trials and observational studies with meta-analysis.
520			_aINTERVENTIONS: None.
520			_aMEASUREMENTS 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%).
520			_aOBJECTIVE: To evaluate the effects of single-dose etomidate on the adrenal axis and mortality in patients with severe sepsis and septic shock.
520			_aSETTING: Literature search of EMBASE, Medline, Cochrane Database, and Evidence-Based Medical Reviews.
520			_aSUBJECTS: Sepsis patients who received etomidate for rapid sequence intubation.
546			_aEnglish
650			_a*Adrenal Insufficiency/ci [Chemically Induced]
650			_a*Anesthetics, Intravenous/ae [Adverse Effects]
650			_a*Etomidate/ae [Adverse Effects]
650			_a*Sepsis/co [Complications]
650			_a*Sepsis/mo [Mortality]
650			_aAged
650			_aAged, 80 and over
650			_aFemale
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aQualitative Research
650			_aRandomized Controlled Trials as Topic
651			_aMedStar Washington Hospital Center
656			_aMedicine/Pulmonary-Critical Care
657			_aJournal Article
657			_aMeta-Analysis
657			_aReview
700			_aChan, Chee Man
700			_aMitchell, Anthony L
700			_aShorr, Andrew F
790			_aChan CM, Mitchell AL, Shorr AF
856			_uhttp://dx.doi.org/10.1097/CCM.0b013e31825fec26 _zhttp://dx.doi.org/10.1097/CCM.0b013e31825fec26
942			_cART _dArticle
999			_c1150 _d1150