Discussion
critically ill, peri-intubation adverse, peri-intubation, peri-intubation cardiac arrest, hypotension, ill, sepsis
ADVERSE EVENTS, SEPSIS, CRITICALLY ILL
The main goal of this study was to compare the clinical outcomes between the two induction agents that are most commonly used for emergency intubation in EDs. We found no significant differences in survival at 24 h, 7 days, and 28 days in sepsis patients intubated with etomidate or ketamine. We also found no significant difference in patients’ physiological parameters after intubation and peri-intubation adverse events, including (1) peri-intubation cardiac arrest, (2) failed intubation, and (3) postintubation hypotension. However, there were significant differences between the etomidate group and the ketamine group in the proportion of patients who required a vasopressor within 24 h after intubation and received intravenous corticosteroids.There is controversy regarding the safety of single-dose etomidate as an induction agent for emergency intubation in patients with sepsis. Several RCTs compared mortality outcomes between etomidate and alternative induction agentsEtomidate can suppress the adrenal synthesis of cortisol by inhibiting 11-β hydroxylase, the enzyme responsible for the conversion of 11-deoxycortisol to cortisolPrevious studies comparing etomidate and ketamine in acutely ill patients showed that there were no differences in major peri-intubation adverse events, including peri-intubation cardiac arrest, change in blood pressure after intubation, and the total volume of intravenous fluid needed after intubationSingle-dose induction agents can impact patients’ haemodynamic status, especially in critically ill patients who need emergency intubation. Although both etomidate and ketamine are considered haemodynamically stable induction agents, there remain concerns that they might cause postintubation hypotension, particularly in patients with sepsisMulticentre observational studies have reported that ketamine is associated with higher risks of postintubation hypotension after emergency intubation than alternative agents