The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial

Knack, Sarah KS; Prekker, Matthew E.; Moore, Johanna C.; Klein, Lauren R.; Atkins, Alexandra H; Miner, James R.

doi:10.1016/j.jemermed.2023.06.009

Cited by 9 publications

(1 citation statement)

References 55 publications

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“…A 469-patient RCT found ketamine to be a safe alternative to etomidate [ 8 ]. Ketamine demonstrated no harm to traumatic brain injury (TBI) patients in a shortcut review [ 9 ] and no difference in 30-day mortality rate compared to etomidate in a 2023 study [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials

Abdildin,

Tapinova,

Nemerenova

et al. 2024

ACC

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Background: This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients.Methods: We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.Results: Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome.Conclusions: Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

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Section: Introductionmentioning

confidence: 99%

The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials

Abdildin,

Tapinova,

Nemerenova

et al. 2024

ACC

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Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study

Karamchandani,

Nasa,

Jarzebowski

et al. 2024

Intensive Care Med

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The Physiologically Difficult Airway and Management Considerations

Mosier

2024

Curr Anesthesiol Rep

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Purpose of Review This paper evaluates the recent literature regarding the physiologically difficult airway. Recent Findings Adverse events mainly desaturation, cardiovascular collapse, and cardiac arrest remain common complications. This risk is greatly increased in patients with altered physiology prior to intubation. Studies published over the last 5 years have explored many aspects surrounding the epidemiology, risks, and approach to managing the physiologically difficult airway. Summary Important work has been done to identify directly modifiable risks of complications related to the physiologically difficult airway, but a large percentage of patients remain at high risk despite optimizing induction agents, preoxygenation, and first attempt success.

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The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial

Cited by 9 publications

References 55 publications

The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials

The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials

Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study

The Physiologically Difficult Airway and Management Considerations

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