The Effect of Etomidate on Patient Outcomes After Single Bolus Doses

Rationale: Although the use of the drug etomidate for continuous sedation in mechanically
ventilated patients was found to have detrimental effects on patient mortality shortly after
its introduction into clinical practice, etomidate continues to be widely used as an
induction agent for endotracheal intubation. Recent data have called into question the
safety of using etomidate for even a single bolus in patients at risk of adrenal
insufficiency, emphasizing the fact that single bolus doses of etomidate cause measurable
adrenal suppression, and consequently may cause an increase in vasopressor requirements and
hospital length of stay. Alternative FDA-approved induction agents, such as midazolam, are
claimed by many authors to be safer than etomidate; however, no studies have formally
compared these agents.

Research Hypothesis: The investigators hypothesize that in critically ill adult patients
presenting to the emergency department with sepsis and requiring rapid sequence intubation,
the hospital length of stay of patients given etomidate will be increased compared to
patients given midazolam for induction.

Specific Aims: The specific aim is to determine the difference in hospital length of stay
between septic patients given etomidate and those given midazolam for induction during rapid
sequence intubation in the emergency department. The investigators plan to compare the two
groups in terms of length of hospital stay, length of ICU stay, and duration of intubation
by performing a prospective, randomized, trial of critically ill patients presenting to the
emergency department with sepsis requiring intubation. The investigators will also compare
the mortality rates in these two groups while controlling for severity of illness and the
use of steroids while hospitalized. Significance: If the use of etomidate to induce
anesthesia prior to intubation is found to adversely affect the length of stay of septic
patients, a reduction in the length of stay in such patients might be achieved by using
alternative agents for induction. The current widespread use of an induction agent that may
adversely affect the length of stay of septic patients has significant implications for
patient management.