We found the retrospective review by Cotton et al1 regarding single-dose etomidate use and adrenal suppression concerning. However, we question the internal validity of the study design and caution against indicting single-dose etomidate in the airway management of trauma patients.
First, there is obvious selection bias in studying only patients in whom the clinicians suspected adrenal insufficiency (AI). Of approximately 2700 patients admitted to the trauma intensive care unit during the study period, only 198 (7%) underwent a cosyntropin stimulation test; 137 (5%) patients were eligible for analysis.
Mullins ME, Theodoro DL. Lack of Evidence for Adrenal Insufficiency After Single-Dose Etomidate. Arch Surg. 2008;143(8):808-809. doi:10.1001/archsurg.143.8.808-c