SynthesisIntensive care medicine2011
The effect of etomidate on adrenal function in critical illness: a systematic review.
Synthesis in Intensive care medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
59 citing papers in PubMed, 4 syntheses or guidelines pooled it, 176 citations in OpenAlex.
- Induction agents for emergency tracheal intubation in critically ill adults: a systematic review and network meta-analysis.Critical care (London, England) · 2026Pooled 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
- Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis.Intensive care medicine · 2014Pooled it
- [Preclinical management of multiples injuries: S3 guideline].Der Unfallchirurg · 2012Guideline
- Remimazolam vs Etomidate: Haemodynamic Effects in Hypertensive Elderly Patients Undergoing Non-Cardiac Surgery.Drug design, development and therapy · 2023Trial
- Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial.Drug design, development and therapy · 2023Trial
- EtomidateWorld journal of clinical cases · 2021Trial
- Trial
- Clinical study of etomidate emulsion combined with remifentanil in general anesthesia.Drug design, development and therapy · 2013Trial
- Etomidate increases susceptibility to pneumonia in trauma patients.Intensive care medicine · 2012Trial
- Trial
- Hemodynamic Effects of Anesthetics, Sedatives, and Analgesics in the CICU: Clinical Decision Guidance.JACC. Advances · 2026Review
- The Pharmacology of Physiologically Difficult Airway Management and Impact on Hemodynamics: A Review.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Review
- Remimazolam-based anesthesia in sepsis patients: a retrospective cohort study of hemodynamic stability and postoperative outcomes.Frontiers in medicine · 2026Article
- Ketamine, Etomidate, and Mortality in Emergency Department Intubations.JAMA network open · 2025Observational
- Pharmacokinetics, Pharmacodynamics, and Safety of ET-26 in Subjects with Mild to Moderate Renal Impairment.Drugs in R&D · 2025Article
- Comparison of Esketamine and Propofol for Prehospital Emergency Anaesthesia in Patients With Traumatic Brain Injury-A Retrospective Observational Study.Acta anaesthesiologica Scandinavica · 2025Observational
- Article
- Cortisol Levels During First Admission Day Are Associated With Clinical Outcomes in Surgical Critically Ill Patients.Critical care explorations · 2024Article
- Nanotherapeutics for Alleviating Anesthesia-Associated Complications.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAlthough etomidate is a preferred anesthetic agent for rapid sequence intubation (RSI) in critical illness, as an inhibitor of cortisol synthesis (11β-hydroxylase), it may be associated with adrenal dysfunction. The objectives are to review the effects of etomidate versus comparator anesthetics in critical illness for: primary outcome of mortality and secondary outcome of adrenal insufficiency (AI).
methodsStudies were extracted using MEDLINE and SCOPUS, regardless of language, between 1983 and 2010 using the keywords etomidate, intensive care units (ICU), critical illness, intensive care, glucocorticoids, and adrenal insufficiency. Studies of single dose etomidate versus comparator anesthetics with outcomes of adrenal function and/or mortality were included. All reviewers performed electronic data searches. One reviewer extracted data, which were checked by the other reviewers. Authors of trials were contacted for supplemental data. Primary outcome was 28-day mortality. AI was defined per article.
resultsTwo hundred sixty-three articles were screened, and 21 articles (19 independent data sets) were evaluated. Meta-analysis comparing etomidate versus non-etomidate anesthesia demonstrated an increased risk ratio (RR) for AI of 1.64 (range 1.52-1.77; 14 studies, 2,854 patients, P<0.0001, I(2)=88%) and an increased RR for mortality of 1.19 (1.10-1.30; 14 studies, 3,516 patients, P<0.0001, I(2)=64%). Significance of re-analysis for mortality within the subset of sepsis was maintained [RR 1.22 (1.11-1.35), 7 studies, n=1,767, I(2)=74%, P<0.0001], but not for trials without sepsis [RR=1.15 (0.97-1.35), 7 studies, n=1,749, I(2)=53%, P=0.10].
conclusionsThere is an increased rate of AI and mortality in critically ill patients who received etomidate.
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Registered trials
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.