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J Crit Care. 2014 Jun;29(3):386-9. doi: 10.1016/j.jcrc.2013.12.018. Epub 2014 Jan 3.

Relative adrenal insufficiency in critically ill patient after rapid sequence intubation: KETASED ancillary study.

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Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France; Université Pierre et Marie Curie Paris 6 (Sorbonne Université), Paris, France. Electronic address:
Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France; SAMU de Paris, Hôpital Necker-Enfants Malades, APHP, Paris, France; INSERM Unité 970, Centre de Recherche Cardiovasculaire de Paris, Université Paris Descartes, Paris, France.
Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France.



Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI.


A prespecified ancillary study of KETASED, a randomized prospective multicenter trial, was conducted. Three hundred ten patients who underwent RSI in an out-of-hospital setting had baseline cortisol and adrenocorticotropic hormone response test measurements within 24 hours of intensive care unit admission and were included.


The mean (SD) age was 55 (19) years, with a mean (SD) Sequential Organ Failure Assessment score of 9 (4). Two hundred forty-seven (69%) patients presented with RAI. Baseline characteristics were similar between patients with and without RAI, except for the use of etomidate as a sedative agent (63% of patients with RAI vs 21%, P<.001), and history of chronic kidney disease. There was no difference in terms of 28-day mortality between the 2 groups (21% vs 19%, P=.65) and in terms of other 28-day prognosis end points.


In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.


Adrenal insufficiency; Etomidate; RSI

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