Sokolove P E, Price D D, Okada P
Division of Emergency Medicine, University of California Davis School of Medicine, Davis and UC Davis Medical Center, Sacramento, 95817, USA.
Pediatr Emerg Care. 2000 Feb;16(1):18-21. doi: 10.1097/00006565-200002000-00005.
To determine whether pediatric patients given etomidate for rapid sequence intubation (RSI) in the ED develop clinically important hypotension or adrenal insufficiency.
Retrospective review of 100 consecutive patients younger than age 10 years given etomidate for RSI in the ED at two academic medical centers. Data were abstracted from ED and in-patient medical records. Clinically important hypotension was defined as a decrease in systolic blood pressure (BP) measurement to below one standard deviation (SD) of mean normal for age. Clinically important adrenal insufficiency was defined as the need for exogenous corticosteroid replacement for suspected adrenal insufficiency at any time during hospitalization.
BP measurements before and within 20 minutes after etomidate administration for RSI were recorded on 84 intubations (84%). The mean change in BP between pre-intubation and post-intubation measurements was a decrease of 1 mmHg (95% CI: -6 mm Hg to +7 mm Hg, P = 0.83). When expressed as a percentage of normal BP for age, the mean change in BP was a decrease of 1% (95% CI: -7% to +6%, P = 0.82). Four patients (4.8%; 95% CI: 1.3-11.7%) had a systolic BP decrease to below one SD of mean normal for age. Fourteen patients received corticosteroids during hospitalization, but none (0/99, 95% CI: 0-3.7%) for suspected adrenal insufficiency.
We found no evidence of clinically important adrenocorticoid suppression and a low incidence of clinically important hypotension when using etomidate for emergent pediatric RSI. Because other induction agents may also result in hypotension, prospective comparison studies are needed to further evaluate the safety of etomidate in this patient population.
确定在急诊科接受依托咪酯进行快速序贯诱导插管（RSI）的儿科患者是否会出现具有临床意义的低血压或肾上腺功能不全。
对两家学术医疗中心急诊科100例连续接受依托咪酯进行RSI的10岁以下患者进行回顾性研究。数据从急诊科和住院病历中提取。具有临床意义的低血压定义为收缩压测量值降至低于年龄平均正常值的一个标准差（SD）。具有临床意义的肾上腺功能不全定义为住院期间任何时间因疑似肾上腺功能不全而需要外源性皮质类固醇替代治疗。
对84次插管（84%）记录了依托咪酯用于RSI给药前及给药后20分钟内的血压测量值。插管前和插管后测量的血压平均变化为下降1 mmHg（95%CI：-6 mmHg至+7 mmHg，P = 0.83）。以年龄正常血压的百分比表示时，血压平均变化为下降1%（95%CI：-7%至+6%，P = 0.82）。4例患者（4.8%；95%CI：1.3 - 11.7%）收缩压降至低于年龄平均正常值的一个标准差。14例患者在住院期间接受了皮质类固醇治疗，但无一例（0/99，95%CI：0 - 3.7%）因疑似肾上腺功能不全接受治疗。
我们发现，在儿科患者紧急RSI中使用依托咪酯时，没有证据表明存在具有临床意义的肾上腺皮质抑制，且具有临床意义的低血压发生率较低。由于其他诱导药物也可能导致低血压，因此需要进行前瞻性比较研究，以进一步评估依托咪酯在该患者群体中的安全性。
