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Michael E. Mullins, MD; Daniel L. Theodoro, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We found the retrospective review by Cotton et al¹ regarding single-dose etomidate use and adrenal suppression concerning. However, we question the internal validity of the study design and caution against indicting single-dose etomidate in the airway management of trauma patients.

First, there is obvious selection bias in studying only patients in whom the clinicians suspected adrenal insufficiency (AI). Of approximately 2700 patients admitted to the trauma intensive care unit during the study period, only 198 (7%) underwent a cosyntropin stimulation test; 137 (5%) patients were eligible for analysis.

Second, severe illness confounds the exposure and outcome. Patients with AI were more likely to have hemorrhagic shock, prolonged vasopressor use, and coagulopathy. All of these signify greater severity of illness and increase the risk of AI. Hemodynamically unstable patients are more likely to receive etomidate in the emergency department.

Third, the absence of . . . [Full Text of this Article]

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Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients
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