Randomization and treatment
sepsis, Sepsis, Septic Shock
SEPSIS, SEPSIS, RSI, SEPTIC SHOCK
Patients were randomly assigned to receive a single-dose induction agent consisting of either etomidate (Lipuro, B. Braun Melsungen, Germany) administered as a 0.2–0.3 mg/kg intravenous bolus or ketamine (Ketalar, PAR Pharmaceutical, Ireland) administered as a 1–2 mg/kg intravenous bolus. The randomization sequence was determined using a computer-generated randomization table with a block size of four by a statistician who was not involved in determining the patient eligibility, drug administration, intubating procedure, or outcome assessment. The drug allocation sequence was kept inaccessible to the research team throughout the study period. Patient assignments were placed into sequentially numbered sealed opaque envelopes. The emergency physician enrolling patients was responsible for opening these envelopes and preparing the study agent but was not involved in the intubation process. None of the emergency physicians enrolling patients were members of the staff in the inpatient ward, and they had no influence on the management of the patients after they were admitted to the hospital.All patients received the same standard RSI protocol, except for the single-dose induction agent. The use of a neuromuscular blocking agent immediately after induction (succinylcholine as a 1.5 mg/kg intravenous bolus) depended on the clinical state of the patient and the presence of any contraindications. Patients were intubated by either the direct laryngoscopy technique (Macintosh) or video laryngoscopy technique (GlideScope). Intratracheal tube positioning was confirmed by clinical assessments and capnometers with capnographs.The definition of sepsis was based on the Third International Consensus Definitions for Sepsis and Septic Shock