A new study from the university of Chicago is saying it doesn't matter which induction agent you use in septic patients or others:
http://ccforum.com/content/11/3/R56
http://ccforum.com/content/11/3/R56
-
CycleTrack and SDN are teaming up to make medical school admissions more transparent and accessible! Read the announcement to learn how we’re supporting the future of CycleTrack’s free application-tracking tools .
Etomidate revisited
Started by Planktonmd
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
Here is the abstract if you can't open the link:
Etomidate, sepsis, and adrenal function: not as bad as we thought?
Ryan Kamp and John P Kress
University of Chicago Hospitals, S Maryland Avenue, Chicago, Illinois 60637, USA
Critical Care 2007, 11:145 doi:10.1186/cc5939
Published 28 June 2007
See related research by Ray et al., http://ccforum.com/content/11/3/R56
Abstract
The choice of induction agent for endotracheal intubation can have significant downstream effects, especially in critically ill patients. In a retrospective study, Ray and McKeown found that the choice of induction agent had no significant effect on use of vasoactive medications, corticosteroids, or mortality. Given the heated debate regarding corticosteroids in septic shock and the role that etomidate may play in leading to adrenal insufficiency, enthusiasm for etomidate as an induction agent should be tempered by its possible, significant side effects in these critically ill patients.
Etomidate, sepsis, and adrenal function: not as bad as we thought?
Ryan Kamp and John P Kress
University of Chicago Hospitals, S Maryland Avenue, Chicago, Illinois 60637, USA
Critical Care 2007, 11:145 doi:10.1186/cc5939
Published 28 June 2007
See related research by Ray et al., http://ccforum.com/content/11/3/R56
Abstract
The choice of induction agent for endotracheal intubation can have significant downstream effects, especially in critically ill patients. In a retrospective study, Ray and McKeown found that the choice of induction agent had no significant effect on use of vasoactive medications, corticosteroids, or mortality. Given the heated debate regarding corticosteroids in septic shock and the role that etomidate may play in leading to adrenal insufficiency, enthusiasm for etomidate as an induction agent should be tempered by its possible, significant side effects in these critically ill patients.
Thanks for the info. The controversy continues over etomidate. You would think by now a large multicenter trial would be underway to answer this question. We need a few thousand patients to get a more accurate picture of Etomidate.
Recently, I used the propofol 50 mg plus 30 mg Ketamine for induction on an ASA4 critically ill patient. It worked great and BIS went to 40 after the induction dose. No change in HR with only a minimal decrease in BP.
Still, etomidate may be a better induction agent than ketafol but again, a good clinical trial is needed.
Blade
On the type of patient that requires etomidate i'm sure a 30/30 mix will give you a 40 read on the bis, or you can go with the 5cc induction: midaz/k/sufenta/sux 😎
My hospital doesn't carry Vec.. but could be nice i like the midaz to cover amnesia though
