This falls into the “don’t use etomidate” pile of literature. Well-demonstrated, primarily in the pediatric literature, that etomidate and its association with adrenal insufficiency results in poorer outcomes in shock. This article doesn’t look at etomidate, but rather it describes relative or absolute adrenal insufficiency in pediatric shock, and finds it relatively pervasive. It then finds an association between their two definitions of adrenal insufficiency and length of stay, length of ventilator days, and required doses of vasopressors. They only 5% mortality in their study, so they can’t comment on any mortality association.
So, this is another study that helps describe why etomidate may be contributing to poorer outcomes. The days of ketamine + rocuronium RSI are coming (we’ll save the succinylcholine vs rocuronium debate for another day).