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Commentary

Etomidate for intubation of patients who have sepsis or septic shock - where do we go from here?

Donald EG Griesdale

Author Affiliations

Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, 855 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9

Department of Anesthesia, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, 855 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9

Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9

Critical Care 2012, 16:189  doi:10.1186/cc11889


See related research by Jung et al., http://ccforum.com/content/16/6/R224

Published: 27 December 2012

Abstract

Etomidate is an intravenous induction agent that is associated with hemodynamic stability during intubation. The agent is therefore attractive for use in critically ill patients who have a high risk of hemodynamic instability during this procedure. However, etomidate causes adrenal suppression, which itself has been associated with increased mortality in critically ill patients. The ongoing debate surrounding use of etomidate is thus centered on the immediate favorable hemodynamic profile versus the long-term risks of adrenal insufficiency, particularly in patients who have severe sepsis or septic shock.