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Should We Use Etomidate as an Induction Agent for Endotracheal Intubation in Patients With Septic Shock?^*

A Critical Appraisal

^* From the Critical Care Medicine Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC.

Correspondence to: William L. Jackson, Jr, MD, FCCP, Walter Reed Army Medical Center, Department of Surgery, Critical Care Medicine Service, Building 2, Room 3M12, 6900 Georgia Ave NW, Washington, DC 20307-5001; e-mail: William.Jackson1{at}NA.AMEDD.ARMY.MIL

Etomidate is commonly used for the facilitation of endotracheal intubation. While etomidate possesses multiple qualities that are beneficial in hemodynamically unstable patients who require a sedative or amnestic, its potential to negatively impact corticosteroid production is well-documented. Given the frequency of relative adrenal insufficiency observed in the critically ill and the increasing use of corticosteroids in patients with septic shock, an appraisal of the status of etomidate as an induction agent in patients with evolving or established septic shock is indicated. A review of the relevant literature suggests that its use in this setting may be harmful. It is proposed that, pending the performance of a randomized, controlled clinical trial, considerable caution should accompany its administration in patients with evolving or established septic shock. The potential role for concomitant empiric steroid replacement and the comparability of alternative induction regimens are also discussed.

Key Words: adrenal insufficiency • endotracheal intubation • etomidate • sepsis • septic shock

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