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One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis

(2008) INTENSIVE CARE MEDICINE. 34(1). p.163-168
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Abstract
Objective: To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis. Design: Retrospective study conducted between 1997 and 2004. Setting: University-affiliated paediatric intensive care unit (PICU). Patients and participants: Sixty children admitted to the PICU with meningococcal sepsis, not treated with steroids. Interventions: Adrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12h and 24h. To assess disease severity, PRISM score and selected laboratory parameters were determined. Measurements and main results: On admission, before blood was drawn, 23 children had been intubated with etomidate, 8 without etomidate and 29 were not intubated. Children who were intubated had significantly higher disease severity parameters than those not intubated, whereas none of these parameters significantly differed between children intubated with or without etomidate. Children who received etomidate had significantly lower cortisol, higher ACTH and higher 11-deoxycortisol levels than those who did not receive etomidate. Arterial glucose levels were significantly lower in children who were intubated with etomidate than in non-intubated children. When children were intubated with etomidate, cortisol levels were 3.2 times lower for comparable 11-deoxycortisol levels. Eight children died, seven of whom had received etomidate. Within 24h cortisol/ACTH and cortisol/11-deoxycortisol ratios increased significantly in children who received etomidate, but not in children who did not, resulting in comparable cortisol/ACTH ratios with still significantly lowered cortisol/11-deoxycortisol ratios 24h after admission. Conclusions: Our data imply that even one single bolus of etomidate negatively influences adrenal function for at least 24h. It might therefore increase risk of death.
Keywords
meningococcal disease, child, INTUBATION, MORTALITY, CORTISOL, INHIBITION, SECRETION, INFUSION, THERAPY, CELLS, adrenal insufficiency, etomidate, critical illness, SEPTIC SHOCK, INDUCTION AGENT

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MLA
DEN BRINKER, MARIEKE et al. “One Single Dose of Etomidate Negatively Influences Adrenocortical Performance for at Least 24 h in Children with Meningococcal Sepsis.” INTENSIVE CARE MEDICINE 34.1 (2008): 163–168. Print.
APA
DEN BRINKER, M., Hokken-Koelega, A. C. S., Hazelzet, J. A., de Jong, F. H., Hop, W. C. J., & Joosten, K. F. M. (2008). One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis. INTENSIVE CARE MEDICINE, 34(1), 163–168.
Chicago author-date
DEN BRINKER, MARIEKE, Anita C. S. Hokken-Koelega, Jan A. Hazelzet, Frank H. de Jong, Wim C. J. Hop, and Koen F. M. Joosten. 2008. “One Single Dose of Etomidate Negatively Influences Adrenocortical Performance for at Least 24 h in Children with Meningococcal Sepsis.” Intensive Care Medicine 34 (1): 163–168.
Chicago author-date (all authors)
DEN BRINKER, MARIEKE, Anita C. S. Hokken-Koelega, Jan A. Hazelzet, Frank H. de Jong, Wim C. J. Hop, and Koen F. M. Joosten. 2008. “One Single Dose of Etomidate Negatively Influences Adrenocortical Performance for at Least 24 h in Children with Meningococcal Sepsis.” Intensive Care Medicine 34 (1): 163–168.
Vancouver
1.
DEN BRINKER M, Hokken-Koelega ACS, Hazelzet JA, de Jong FH, Hop WCJ, Joosten KFM. One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis. INTENSIVE CARE MEDICINE. 2008;34(1):163–8.
IEEE
[1]
M. DEN BRINKER, A. C. S. Hokken-Koelega, J. A. Hazelzet, F. H. de Jong, W. C. J. Hop, and K. F. M. Joosten, “One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis,” INTENSIVE CARE MEDICINE, vol. 34, no. 1, pp. 163–168, 2008.
@article{744613,
  abstract     = {Objective: To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis. Design: Retrospective study conducted between 1997 and 2004. Setting: University-affiliated paediatric intensive care unit (PICU). Patients and participants: Sixty children admitted to the PICU with meningococcal sepsis, not treated with steroids. Interventions: Adrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12h and 24h. To assess disease severity, PRISM score and selected laboratory parameters were determined. Measurements and main results: On admission, before blood was drawn, 23 children had been intubated with etomidate, 8 without etomidate and 29 were not intubated. Children who were intubated had significantly higher disease severity parameters than those not intubated, whereas none of these parameters significantly differed between children intubated with or without etomidate. Children who received etomidate had significantly lower cortisol, higher ACTH and higher 11-deoxycortisol levels than those who did not receive etomidate. Arterial glucose levels were significantly lower in children who were intubated with etomidate than in non-intubated children. When children were intubated with etomidate, cortisol levels were 3.2 times lower for comparable 11-deoxycortisol levels. Eight children died, seven of whom had received etomidate. Within 24h cortisol/ACTH and cortisol/11-deoxycortisol ratios increased significantly in children who received etomidate, but not in children who did not, resulting in comparable cortisol/ACTH ratios with still significantly lowered cortisol/11-deoxycortisol ratios 24h after admission. Conclusions: Our data imply that even one single bolus of etomidate negatively influences adrenal function for at least 24h. It might therefore increase risk of death.},
  author       = {DEN BRINKER, MARIEKE and Hokken-Koelega, Anita C. S. and Hazelzet, Jan A. and de Jong, Frank H. and Hop, Wim C. J. and Joosten, Koen F. M.},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keywords     = {meningococcal disease,child,INTUBATION,MORTALITY,CORTISOL,INHIBITION,SECRETION,INFUSION,THERAPY,CELLS,adrenal insufficiency,etomidate,critical illness,SEPTIC SHOCK,INDUCTION AGENT},
  language     = {eng},
  number       = {1},
  pages        = {163--168},
  title        = {One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis},
  url          = {http://dx.doi.org/10.1007/s00134-007-0836-3},
  volume       = {34},
  year         = {2008},
}

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