Critics have uncovered a number of key flaws in the VISEP study, the most significant of which center around the paired use of hydroxyethyl starch and key faults involving study enrollment. Like others who have reported high levels of hypoglycemia, VISEP researchers used long monitoring intervals for blood glucose surveillance (4 hours) regardless of the use of high dose intravenous insulin. One major potential contributor to the negative VISEP results was the hypoglycemia rate of their protocol (%) which likely masked any potential benefit of intensive insulin therapy. Likewise, centers who have invested in the use of intensive glycemic control have shown remarkably lower glycemic rates (<3%) even with tight control (80-110 mg/dL) with frequent blood glucose measurements (hourly).
Etomidate is usually presented as a clear colourless solution for injection containing 2 mg/ml of etomidate in an aqueous solution of 35% propylene glycol , although a lipid emulsion preparation (of equivalent strength) has also been introduced. Etomidate was originally formulated as a racemic mixture,  but the R form is substantially more active than its enantiomer .  It was later reformulated as a single-enantiomer drug, becoming the first general anesthetic in that class to be used clinically. 
One aspect that is clear from existing studies is that we need to be more focused and realistic in the questions being asked of steroid therapy in sepsis. Are short-term goals such as reversal of shock sufficient or should we be judging effects on mortality over longer periods? Clinicians, witnessing benefits occurring over hours to days, are less able to judge potentially deleterious effects occurring over weeks. We may fail to notice or quantify the fact that corticosteroids have caused infection or muscle weakness and delayed rehabilitation (key factors in the long-term recovery of patients). Despite early reversal of shock, in the longer term the victory may be Pyrrhic. We await the recently registered Australian ESCAPE trial (Evaluation in Sepsis of Corticosteroids and Placebo) of steroids in septic shock with anticipation; this study will assess 90-day mortality and may provide us with a better appreciation of longer term outcomes ( http:///ct2/show/NCT01448109 ).