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To the Editor: Dr Annane and colleagues¹ excluded patients who received etomidate before intubation because this agent could interfere with cortisol response to corticotropin. However, the authors do not provide the number of patients excluded on this basis. Furthermore, this exclusion criterion was not implemented until halfway through the data collection phase. It would be of interest to know how many included in this study received etomidate prior to that. It also would be of interest to know the effect of removing these patients from the data analysis. This would help answer the question of whether patients with septic shock who have received etomidate should be routinely treated with exogenous corticosteroids.

Christina L. Schenarts, MD; Juan A. March, MD
Department of Emergency Medicine
East Carolina University
Greenville, NC

1. Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862-871. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:41.

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