Trial reportIntensive care medicine2009
The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock.
Trial report in Intensive care medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
64 citing papers in PubMed, 5 syntheses or guidelines pooled it, 215 citations in OpenAlex.
- Anesthetic induction drugs during tracheal intubation in critically ill patients: a systematic review.Journal of anesthesia · 2026Pooled it
- Efficacy of ketamine versus etomidate for rapid sequence intubation of critically ill patients in terms of mortality and success rate: a systematic review and meta-analysis of randomized controlled trials.Clinical and experimental emergency medicine · 2025Pooled it
- Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.The Cochrane database of systematic reviews · 2015Pooled it
- Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.Intensive care medicine · 2013Guideline
- The effect of etomidate on adrenal function in critical illness: a systematic review.Intensive care medicine · 2011Pooled it
- Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults.The New England journal of medicine · 2026Trial
- Clinical outcomes after a single induction dose of etomidate versus ketamine for emergency department sepsis intubation: a randomized controlled trial.Scientific reports · 2023Trial
- Comparison of Adrenal Suppression between Etomidate and Dexmedetomidine in Children with Congenital Heart Disease.Medical science monitor : international medical journal of experimental and clinical research · 2015Trial
- Etomidate increases susceptibility to pneumonia in trauma patients.Intensive care medicine · 2012Trial
- Etomidate and mortality in cirrhotic patients with septic shock.BMC clinical pharmacology · 2011Trial
- Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial.Annals of cardiac anaesthesiaTrial
- Perioperative management of septic peritonitis in small animals: A review.Veterinary surgery : VS · 2026Review
- Ketamine, Etomidate, and Mortality in Emergency Department Intubations.JAMA network open · 2025Observational
- Protocol and Statistical Analysis Plan for a Multicenter Randomized Trial of Ketamine vs Etomidate for Emergency Tracheal Intubation.CHEST critical care · 2025Article
- Evidence-based Emergency Tracheal Intubation.American journal of respiratory and critical care medicine · 2025Review
- Article
- An Expiration Date for Etomidate?American journal of respiratory and critical care medicine · 2024Article
- Induction agents for emergency airway management in critically ill patients.Indian journal of anaesthesia · 2024Article
- Strategies to Minimize Virus Transmission During Anesthesia Procedures in COVID-19 Patients.Anesthesia and critical care (Houston, Tex.) · 2024Article
- A Nomogram Model for Post-Intubation Hypotension in Patients with Severe Pneumonia in the Emergency Department.Journal of inflammation research · 2023Article
4 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 10 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
rationaleUse of etomidate in the critically ill is controversial due to its links with an inadequate response to corticotropin and potential for excess mortality. In a septic shock population, we tested the hypotheses that etomidate administration induces more non-responders to corticotropin and increases mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate.
methodsAn a-priori sub-study of the CORTICUS multi-centre, randomised, double-blind, placebo-controlled trial of hydrocortisone in septic shock. Use and timing of etomidate administration were collected. Endpoints were corticotropin response and all-cause 28-day mortality in patients receiving etomidate. MEASUREMENTS AND MAIN
resultsFive hundred patients were recruited, of whom 499 were analysable; 96 (19.2%) were administered etomidate within the 72 h prior to inclusion. The proportion of non-responders to corticotropin was significantly higher in patients who were given etomidate in the 72 h before trial inclusion than in other patients (61.0 vs. 44.6%, P = 0.004). Etomidate therapy was associated with a higher 28-day mortality in univariate analysis (P = 0.02) and after correction for severity of illness (42.7 vs. 30.5%; P = 0.06 and P = 0.03) in our two multi-variant models. Hydrocortisone administration did not change the mortality of patients receiving etomidate (45 vs. 40%).
conclusionsThe use of bolus dose etomidate in the 72 h before study inclusion is associated with an increased incidence of inadequate response to corticotropin, but is also likely to be associated with an increase in mortality. We recommend clinicians demonstrate extreme caution in the use of etomidate in critically ill patients with septic shock.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.