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Adrenal Insufficiency and Ventilator Weaning: Additional Study Is Required

Considering Dr. Jackson's comments on our recent article (1), we agree that the use of etomidate would suppress steroidogenesis and adrenal function and obscure the identification of adrenal insufficiency (2, 3). None of the patients enrolled in our study received etomidate because the drug was not available in our hospital. Corticosteroid administration has been suggested in patients with septic shock, but the mechanism could not be explained by the previous study (4). We believe there are some difficulties in conducting clinical studies on adrenal insufficiency (AI). First, relative adrenal insufficiency that frequently occurs in critically ill patients is usually asymptomatic. Therefore, its prevalence and importance are underestimated. Second, the effect of corticosteroid supplementation is difficult to quantify directly in clinical research. Though corticosteroids may improve hemodynamic stability and suppress cytokine concentrations, additional study is required to define their actual effects (5). Third, the optimal timing to evaluate adrenal function is debatable. The response of the adrenal gland to environmental stimulation varies in different patients and at different time points. So far, no consensus has been established in evaluating adrenal function in critically ill patients. It remains difficult for clinicians to recognize the prevalence of adrenal insufficiency in critically ill patients and to modify their practice accordingly.

Chung-Jen Huang and Horng-Chyuan Lin

Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

FOOTNOTES

Conflict of Interest Statement: C.-J.H. received $2,000 from Roche in June 2004 to attend the Asia Pacific Critical Care Conference in Seoul, Korea. He received $2,000 from Bayer in November 2005 to attend the annual meeting of the Asia Pacific Respiratory Society in Guangzhou, China. H.-C.L. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

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