• Marieke den Brinker, Anita C S Hokken-Koelega, Jan A Hazelzet, Frank H de Jong, Wim C J Hop, and Koen F M Joosten.
• Department of Pediatrics, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
• Intensive Care Med. 2008 Jan 1;34(1):163-8.

ObjectiveTo investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis.DesignRetrospective study conducted between 1997 and 2004.SettingUniversity-affiliated paediatric intensive care unit (PICU).Patients And ParticipantsSixty children admitted to the PICU with meningococcal sepsis, not treated with steroids.InterventionsAdrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12h and 24h. To assess disease severity, PRISM score and selected laboratory parameters were determined.Measurements And Main ResultsOn admission, before blood was drawn, 23 children had been intubated with etomidate, 8 without etomidate and 29 were not intubated. Children who were intubated had significantly higher disease severity parameters than those not intubated, whereas none of these parameters significantly differed between children intubated with or without etomidate. Children who received etomidate had significantly lower cortisol, higher ACTH and higher 11-deoxycortisol levels than those who did not receive etomidate. Arterial glucose levels were significantly lower in children who were intubated with etomidate than in non-intubated children. When children were intubated with etomidate, cortisol levels were 3.2 times lower for comparable 11-deoxycortisol levels. Eight children died, seven of whom had received etomidate. Within 24h cortisol/ACTH and cortisol/11-deoxycortisol ratios increased significantly in children who received etomidate, but not in children who did not, resulting in comparable cortisol/ACTH ratios with still significantly lowered cortisol/11-deoxycortisol ratios 24h after admission.ConclusionsOur data imply that even one single bolus of etomidate negatively influences adrenal function for at least 24h. It might therefore increase risk of death.

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