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首页> 外文期刊>Canadian Journal of Emergency Medicine >Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims
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Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims

机译：依托咪酯单次给药后对插管性颅脑损伤患者的肾上腺抑制作用

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Background:Etomidate is frequently used to intubate traumatic brain injury (TBI) victims, even though it has been linked to adrenal insufficiency (AI) in some populations. Few studies have explored the risk of prolonged etomidateinduced AI among TBI victims.Objective:To determine the risk and the length of AI induced by etomidate in patients intubated for moderate and severe TBI.Methods:Participants in this observational study were moderate to severe intubated TBI victims aged ≥ 16 years. The anesthetic used (etomidate versus others) was determined solely by the treating emergency physician. Adrenocorticotropic hormone (ACTH) stimulation tests (250 μg) were performed 24, 48, and 168 hours after intubation. AI was defined as an increase in serumcortisol 1 hour post–ACTH test (delta cortisol) of less than 248.4 nmol/L.Results:Forty subjects (participation 42.6%) underwent ACTH testing. Fifteen received etomidate, and 25 received another anesthetic. There were no statistically significant differences between groups as to the cumulative incidence of AI at any measurement time. However, at 24 hours, exploratory post hoc analyses showed a significant decrease in delta cortisol (adjusted means: etomidate group: 305.1 nmol/L, 95% CI 214.7–384.8 versus other anesthetics: 500.5 nmol/L, 95% CI 441.8–565.7). This decrease was not present at 48 and 168 hours.Conclusion:In TBI victims, although a single dose of etomidate does not increase the cumulative incidence of AI as defined, it seems to decrease the adrenal response to an ACTH test for 24 hours. The clinical impacts of this finding remain to be determined.
机译：背景：依托咪酯经常被用于插管创伤性脑损伤（TBI）受害者，即使它与某些人群的肾上腺功能不全（AI）有关。很少有研究探讨在TBI患者中延长依托咪酯诱导的AI的风险。目的：确定经依托咪酯诱导的中，重度TBI插管患者的AI风险和时长。方法：本观察研究的参与者为中度至重度TBI插管≥16岁的受害者。使用的麻醉剂（依托咪酯与其他麻醉剂）仅由急诊医师决定。插管后24、48和168小时进行促肾上腺皮质激素（ACTH）刺激试验（250μg）。 AI被定义为ACTH试验后1小时血清皮质醇升高（δ皮质醇）小于248.4 nmol / L。结果：40名受试者（参与率为42.6％）接受了ACTH试验。 15例接受依托咪酯，25例接受另一种麻醉剂。两组之间在任何测量时间的AI累积发生率均无统计学差异。但是，在24小时后，探索性事后分析显示皮质醇δ显着降低（调整后的方法：依托咪酯组：305.1 nmol / L，95％CI 214.7–384.8，而其他麻醉剂：500.5 nmol / L，95％CI 441.8–565.7 ）。结论：在TBI患者中，单次依托咪酯并未增加所定义的AI的累积发生率，但似乎在24小时内降低了对ACTH试验的肾上腺反应。这一发现的临床影响尚待确定。

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