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Abstract

Editor, We thank Luedi et al.1 for their interest in the pro–con debate on etomidate.2–4 Over the past decade many studies and expert opinions have questioned the suitability of etomidate as an induction agent in critically ill patients and the time has probably come for editing official guidelines. As ‘con’ authors we fully agree with the opinion of the authors and their concerns on the use of etomidate in multiple trauma patients. We are pleased to read that the existing evidence presented in our article has been judged sufficiently valid to formulate a recommendation in the guidelines for multiple trauma patients in Germany (www.awmf.org: S3 Leitlinie Polytrauma/Schwerverletzten-Behandlungen 2011). The increased morbidity and prolonged length of hospital stay are good clinical reasons to avoid the use of etomidate in unstable trauma patients. We further emphasise that a very recent meta-analysis confirmed that etomidate is associated with mortality and adrenal insufficiency in the setting of sepsis.5 We therefore reiterate our statement, ‘its use in septic shock should be avoided considering the potential fatal consequences’.4 Acknowledgements relating to this article Assistance with the letter: none. Financial support and sponsorship: none. Conflicts of interest: none. Presentation: none.