Induction Agents for Tracheal Intubation of Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Authors' conclusion
Our results show that when considering sedation agents for endotracheal intubation of critically ill patients, etomidate probably causes less hemodynamic instability during intubation when compared with ketamine.
Study context
- Population
- Critically ill adults or children undergoing endotracheal intubation in the emergency department (ED), ICU, operating room and prehospital setting
- Participants
- 6,031 adults · 21 randomized controlled trials (RCTs)
- Comparison
- Sedative induction agents compared with each other
- Outcome
- Hemodynamic instability during intubation
Methodological detailsfrequentist random-effects model, GRADE certainty rating, Cochrane RoB 2
- Frequentist random-effects model
- GRADE certainty rating
- Cochrane RoB 2
Pooled result
As reported in the abstract
Relative risk (95% CI)
Ketamine vs Etomidatemoderate certainty
1.31(1.15–1.48)
Ketamine-propofol vs Etomidatelow certainty
0.44(0.27–0.72)
Ketamine-propofol vs Ketaminelow certainty
0.34(0.21–0.56)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Initiation of postintubation continuous infusion vasopressorsKetamine vs Etomidate · low certainty | 0.80 (0.50–1.28) | |
| 0.512Relative risk (log scale) |
Safety
- Etomidate caused increased adrenal suppression vs other agents
Original publication
Induction Agents for Tracheal Intubation of Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Chest. Published 18 August 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →