Don’t Give Up on Etomidate for Septic Shock

Etomidate’s excellent hemodynamic stability and short duration of action make it an important induction agent for emergent intubation. Recently, etomidate’s use in patients with septic shock has been questioned because it can interfere with adrenal function for 24 to 72 hours after intubation through inhibition of 11β-hydroxylase. The clinical significance of etomidate-induced adrenal insufficiency remains unclear but has provoked significant controversy.

Researchers conducted a retrospective analysis of data from a prospectively collected database to evaluate whether a single use of various induction agents is associated with adverse outcomes or the need for vasopressors, inotropes, and steroids in patients with septic shock. Among 159 patients for whom complete records were available, the hospital mortality rate was 65%. Etomidate was used in 74 patients, thiopental in 26, propofol in 25, and other agents in 18; no induction agent was used in 16 patients. Severity of illness and mortality rates did not differ significantly among patients given different induction agents. The induction agent used also was not associated with the need for steroids or vasopressors. Patients who received etomidate were less likely to require cardiovascular interventions than were those who received other agents.