Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults.
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Casey Jonathan D, Seitz Kevin P, Driver Brian E, Gibbs Kevin W, Ginde Adit A, Trent Stacy A, Russell Derek W, Muhs Amelia L, Prekker Matthew E, Gaillard John P, Resnick-Ault Daniel, Stewart L Jane, Whitson Micah R, DeMasi Stephanie C, Robinson Aaron E, Palakshappa Jessica A, Aggarwal Neil R, Brainard Jason C, Douin David J, Marvi Tanya K, Scott Benjamin K, Alber Sarah M, Lyle Carolynn, Gandotra Sheetal, Van Schaik Graham W, Lacy Aaron J, Sherlin Kristen C, Erickson Heidi L, Cain J Maycee, Redman Brianne, Beach Logan L, Gould Barbara, McIntosh Jasmine, Lewis Ariel A, Lloyd Bradley D, Israel Tiffany L, Imhoff Brant, Wang Li, Spicer Alexandra B, Churpek Matthew M, Rice Todd W, Self Wesley H, Han Jin H, Semler Matthew W, RSI Investigators and the Pragmatic Critical Care Research Group
Аннотация
METHODS: In a randomized trial conducted in 14 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults who were undergoing tracheal intubation to receive ketamine or etomidate for the induction of anesthesia. The primary outcome was in-hospital death from any cause by day 28. The secondary outcome was cardiovascular collapse during intubation, defined by the occurrence of a systolic blood pressure below 65 mm Hg, receipt of a new or increased dose of vasopressors, or cardiac arrest.
RESULTS: A total of 2365 patients underwent randomization and were included in the trial population; 1176 were assigned to the ketamine group and 1189 to the etomidate group. In-hospital death by day 28 occurred in 330 of 1173 patients (28.1%) in the ketamine group and in 345 of 1186 patients (29.1%) in the etomidate group (risk difference adjusted for trial site, -0.8 percentage points; 95% confidence interval [CI], -4.5 to 2.9; P = 0.65). Cardiovascular collapse during intubation occurred in 260 of 1176 patients (22.1%) in the ketamine group and in 202 of 1189 patients (17.0%) in the etomidate group (risk difference, 5.1 percentage points; 95% CI, 1.9 to 8.3). Prespecified safety outcomes were similar in the two groups.
CONCLUSIONS: Among critically ill adults undergoing tracheal intubation, the use of ketamine to induce anesthesia did not result in a significantly lower incidence of in-hospital death by day 28 than etomidate. (Funded by the Patient-Centered Outcomes Research Institute and others; RSI ClinicalTrials.gov number, NCT05277896.).