CJEM Articles: Rob Green

Clinical questions

1. In critically ill patients with septic shock, does exposure to bolus administration of etomidate increase the risk of inadequate response to corticotropin and mortality compared to no exposure?
2. In critically ill patients with septic shock who are exposed to bolus administration of etomidate, does hydrocortisone reduce the risk of death compared to placebo?

Article chosenCuthbertson BH, Sprung CL, Annane D, et al. The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock. Intensive Care Med 2009;35:1868-76.
Study objectiveThe authors sought to test the hypotheses that bolus doses of etomidate results in an increased proportion of nonresponders to corticotropin and an increase in mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate.