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Concern about cortisol suppression has led some authors to advise caution about use of etomidate in certain patients, such as those who are critically ill or steroid dependent. In a secondary analysis of data collected for an international trial of low-dose hydrocortisone for septic shock, researchers compared corticotropin response and rates of all-cause 28-day mortality in patients who did and who did not receive etomidate. Patients with immunosuppression or underlying diseases associated with poor prognoses and those who had received steroids were excluded.
Of 499 eligible patients from 52 intensive care units, 96 patients (19%) received a bolus dose of etomidate within 72 hours before enrollment in the trial. In one of two multivariate m…