Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Cortisol immunoassays may overor underestimate the actual cortisol level, affecting the assignment of patients to responders or nonresponders [307]. Although the clinical significance is not clear, it is now recognized that etomidate, when used for induction for intubation, will suppress the hypothalamic-pituitary-adrenal axis [308,309]. Moreover, a subanalysis of the CORTICUS trial revealed that the use of etomidate before application of low-dose steroids was associated with an increased 28-day mortality rate [302].…”

Etomidate increases susceptibility to pneumonia in trauma patients

“…The duration of MV was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) days in the nonetomidate group and 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days in the etomidate group (p = 0.275), and the ICU length of stay was 15 (9-28) days in the non-etomidate group and 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days in the etomidate group (p = 0.422). Four (7.4 %) patients in the non-etomidate group and six (6 %) patients in the etomidate group died (p = 1).…”

“…Authors of clinical trials have frequently reported an increased rate of adrenal insufficiency and an increased risk of death with etomidate use [5,6]. In a study involving a general population of intensive care unit (ICU) patients, etomidate did not alter specific outcomes (organ failures, duration of mechanical ventilation) or mortality compared with ketamine [7]. In a recently published systematic review, the authors confirmed an increased mortality rate with the use of etomidate in a sub-group of patients with sepsis [8].…”

Hemodynamic monitoring by USCOM during rapid sequence intubation (RSI) with Etomidate/Fentanyl or Ketamine/Midazolam

“…Ketamine with its known stabilizing effects on hemodynamics might be a reasonable alternative, particularly in septic patients. A recently published randomized trial has shown that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients [7]. Jabre et al, found that the percentage of patients with adrenal insufficiency was significantly higher in the etomidate group than in the ketamine group [7].However, 28-day mortality did not differ significantly.…”