tailieunhanh - Báo cáo y học: "Etomidate and adrenal insufficiency: the controversy continues"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài:Etomidate and adrenal insufficiency: the controversy continues. | Majesko and Darby Critical Care 2010 14 338 http content 14 6 338 CRITICAL CARE JOURNAL CLUB CRITIQUE L Etomidate and adrenal insufficiency the controversy continues Alyssa Majesko and Joseph M Darby Expanded Abstract Citation Jabre P Combes X Lapostolle F et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients a multicentre randomised controlled trial. Lancet 2009 374 293-300. PMID 19573904 Background Critically ill patients often require emergency intubation. The use of etomidate as the sedative agent in this context has been challenged because it may cause a reversible adrenal insufficiency potentially associated with increased in-hospital morbidity. We compared early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients. Methods In this randomized controlled single-blind trial 655 patients who needed sedation for emergency intubation were prospectively enrolled from 12 emergency medical services or emergency departments and 65 intensive care units in France. Patients were randomly assigned by a computerized random-number generator list to receive 0-3 mg kg of etomidate n 328 or 2 mg kg of ketamine n 327 for intubation. Only the emergency physician enrolling patients was aware of group assignment. The primary endpoint was the maximum score of the sequential organ failure assessment during the first 3 days in the intensive care unit. We excluded from the analysis patients who died before reaching the hospital or those discharged from the intensive care unit before 3 days modified intention to treat . This trial is registered with number NCT00440102. Correspondence darbyjm@ University of Pittsburgh Medical Center Department of Critical Care Medicine 3550 Terrace Street 610 Scaife Hall University of Pittsburgh Pittsburgh PA 1 5261 USA 2 BioMed Central 2010 BioMed Central Ltd Findings 234