Ketamine versus alternate agents to prevent postinduction haemodynamic instability during tracheal intubation of critically ill adults: a systematic review and meta-analysis
Authors' conclusion
Ketamine appears associated with less haemodynamic stability than etomidate during the peri-intubation period but might perform more favourably than other agents, with no effect on longer-term outcomes.
Study context
- Population
- Critically ill adults undergoing tracheal intubation in the ED or ICU
- Participants
- 4,673 adults · 10 RCTs
- Comparison
- Ketamine vs alternative induction agents
- Outcome
- Postinduction haemodynamic instability harmonised across trials
Methodological detailsrandom-effects model with Hartung-Knapp adjustment, prospectively registered protocol
- Random-effects model with Hartung-Knapp adjustment
- Prospectively registered protocol
Pooled result
As reported in the abstract
Relative risk (CI)
Ketamine vs Etomidatesignificantly greater risk with ketamine
1.28(1.13–1.45)
Ketamine vs Midazolam and sufentanilketamine appeared superior
0.51(0.29–0.89)
Further pooled results
Mortality, ventilator-free days, ICU-free days
- No differences shown
Original publication
Ketamine versus alternate agents to prevent postinduction haemodynamic instability during tracheal intubation of critically ill adults: a systematic review and meta-analysis. Br J Anaesth. Published 7 April 2026. doi:10.
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