Fentanyl as an induction agent for tracheal intubation in critically ill patients: a systematic review and meta-analysis
Authors' conclusion
The effect of fentanyl on peri-intubation cardiovascular instability remains highly uncertain, with pooled estimates compatible with substantial harm, substantial benefit, or no effect.
Study context
- Population
- Critically ill adults undergoing tracheal intubation
- Participants
- 515 adults · 5 randomized controlled trials (RCTs)
- Comparison
- Induction regimen including fentanyl or its analogs vs one without them
- Outcome
- Peri-intubation cardiovascular instability (definitions varied)
Methodological detailsrandom-effects meta-analysis, trial sequential analysis, GRADE, 2 studies low risk of bias, 2 some concerns, 1 high risk of bias
- Random-effects meta-analysis
- Trial sequential analysis
- GRADE
- 2 studies low risk of bias, 2 some concerns, 1 high risk of bias
Pooled result
As reported in the abstract
Very low certainty
Each group vs no fentanylRelative risk (95% CI)
Fentanyl
1.41(0.83–2.40)
- Fentanyl
- risk difference 9.2% more (95% CI 3.8% fewer to 31.3% more)
- Trial sequential analysis (TSA) required information size not reached, indicating lack of statistical power
- 5586
Further pooled results
Secondary outcomes (hypoxemia, first-attempt success, duration of mechanical ventilation, ICU LOS, mortality)
- Certainty of evidence generally low or very low
Original publication
Fentanyl as an induction agent for tracheal intubation in critically ill patients: a systematic review and meta-analysis. J Intensive Care. Published 7 February 2026. doi:10.
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