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Rationale for routine and immediate administration of intravenous estrogen for all critically ill and injured patients

Wigginton, Jane G. MD; Pepe, Paul E. MD; Idris, Ahamed H. MD

doi: 10.1097/CCM.0b013e3181f243a9
Thinking Outside the Box: Proceedings of a Round Table Conference in Brussels, Belgium, March 2010

In addition to a number of very compelling clinical observations, an extensive body of extremely supportive experimental data has generated a very persuasive argument that intravenous estrogen should be routinely administered, as soon as possible, to all persons identified as having a critical illness or injury. Although, to date, definitive gold-standard clinical trials are lacking, what has made this provocative argument even more convincing is the longstanding, documented safety of intravenous estrogen for various illnesses and conditions as well as the relative ease and inexpensive cost of treatment. As such, even routine prehospital administration becomes extremely feasible for a myriad of conditions. More importantly, the worldwide magnitude of potential patients who could benefit is profound. Even if estrogen only changes the outcome in a relatively small percentage of applicable cases, the potential impact may still be of dramatic proportions in terms of the absolute number of lives saved and the resources spared worldwide. Resources may be spared not only in terms of diminishing the economic impact of death and long-term disability, but also in terms of preventing extended intensive care unit stays and treatment of preventable complications that result in longer recovery.

From the Departments of Internal Medicine (PEP, AHI), Surgery (Emergency Medicine) (PEP, JGW, AHI), Pediatrics (PEP), and School of Public Health (PEP), The University of Texas Southwestern Medical Center and the Parkland Health and Hospital System, Dallas TX; and The Dallas Fort Worth Center for Resuscitation Research (PEP, JGW, AHI), Dallas, TX.

Funded, in part, by the National Institutes of Health (Clinical and Translational Science Award grant number: 5 UL1 RR024982-04).

The article does suggest off-label uses of estrogen, but the U.S. Food and Drug Administration has approved several investigational new drug applications made by the authors to formally study the use of estrogen in conditions mentioned in this text.

The authors have not disclosed any potential conflicts of interest.

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© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins