Etomidate vs midazolam in sepsis

Given that single-dose etomidate can cause measurable adrenal suppression, its use in patients with sepsis is controversial. A prospective, double-blind, randomised study of patients with suspected sepsis who were intubated in the ED randomised patients to receive either etomidate or midazolam before intubation. The primary outcome measure was hospital length of stay, and no difference was demonstrated. The study was not powered to detect a mortality difference.

This study is interesting as a provider of fuel for the ‘etomidate debate’, but still irrelevant to those of us who have abandoned etomidate in favour of ketamine as an induction agent for haemodynamically unstable patients. Personally I remain unconvinced of the existence of patients who can’t be safely intubated using the limited choice of thiopentone or ketamine.

A Comparison of the Effects of Etomidate and Midazolam on Hospital Length of Stay in Patients With Suspected Sepsis: A Prospective, Randomized Study
Annals Emergency Medicine 2010;56(5):481-9