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Respiratory Failure & Mechanical Ventilation

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The RSI Trial

Practical Applications in Clinical Practice

Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults | New England Journal of Medicine


1. No Mortality Benefit

  • The trial found no statistically significant difference in 28-day in-hospital mortality between ketamine (28.1%) and etomidate (29.1%) groups (adjusted risk difference −0.8%, 95% CI −4.5 to 2.9; P = 0.65).

  • Implication: Either agent may be appropriate from a mortality standpoint, allowing clinicians to prioritize other patient-specific factors.

2. Risk Stratification

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Noor Ali Shah
Noor Ali Shah
11 août 2025

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No difference in hypotension or SOFA between Ketamine and Etomidate RSI:

In a single-center study comparing the effects of ketamine and etomidate during Rapid Sequence Intubation (RSI) on critically ill adults, 143 patients were evaluated for the highest SOFA scores and incidence of hypotension post-intubation. The results revealed similar outcomes for both drugs: median SOFA scores were 6.5 for ketamine and 7 for etomidate, with hypotension rates at 28% and 26%, respectively. The thirty-day mortality rates were 11% for those administered ketamine and 21% for etomidate, though the difference was not statistically significant. Thus, both agents showed comparable effects on SOFA scores and hypotension rates in the studied population.


The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial - Journal of Emergency Medicine (jem-journal.com)

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