Etomidate for RSI in Septic Shock Patients

All Pharmacy Pearls

Introduction

sequence intubation in emergency departments in the United

States.

Favorable characteristics include reliably good intubating

conditions, a rapid onset and offset of activity, non-renal

elimination, and maintenance of the cardiorespiratory drive

Unfortunately, etomidate causes relative adrenal insufficiency in

up to 90% of patients after a single dose for up to 48 hours

Serious safety concerns first surfaced in the early 1980’s when

continuous infusions were associated with increased mortality in

trauma patients.

Etomidate

Mechanism of

Action

Short-acting hypnotic, which appears to have

gamma-aminobutyric acid (GABA)-like effects.

Unlike the barbiturates, etomidate reduces

subcortical inhibition at the onset of hypnosis

while inducing neocortical sleep.

Dose

3 mg/kg IV (range 0.2 to 0.6 mg/kg)

Adverse

Effects

Injection site pain (20%)

Clinical Detail

Analytics. Retrieved November 6, 2018, from http://www.micromedexsolutions.com/

McPhee C, et al. Single-dose etomidate is not associated with increased mortality in ICU patients with sepsis:

analysis of a large electronic ICU database. Crit Care Med 2013; 41: 774-83.

den Brinker M, et al. One single dose of etomidate negatively influences adrenocortical performance for at least

24h in children with meningococcal sepsis. Intensive Care Med. 2008 Jan;34(1):163-8.

Tekwani KL, et al. A comparison of the effects of etomidate and midazolam on hospital length of stay in patients

with suspected sepsis: a prospective, randomized study. Ann Emerg Med. 2010 Nov;56(5):481-9.

Jabre P, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre

randomised controlled trial. Lancet. 2009 Jul 25;374(9686):293-300

Cuthbertson BH, et al. The effects of etomidate on adrenal responsiveness and mortality in patients with septic

shock. Intensive Care Med. 2009 Nov;35(11):1868-76.

Chan CM, et al. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis.

Evidence

Evidence details are preserved from the source document in the clinical sections and references.

Conclusions