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The following is a summary of “Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis,” published in the February 2024 issue of Critical Care by Koroki et al.
Despite the high risk of tracheal intubation in critical care, ketamine’s favorable cardiovascular effects suggest it might improve clinical outcomes.
Researchers launched a retrospective study to analyze if, for critically ill patients needing intubation, ketamine offered a mortality advantage compared to other agents.
They searched MEDLINE, Embase, and the Cochrane Library (April 27, 2023), for RCTs and matched observational studies comparing ketamine to any control in critically ill patients undergoing intubation. The primary focus was on mortality over the longest available follow-up period, with secondary measures including Sequential Organ Failure Assessment score, ventilator-free days at day 28, vasopressor-free days at day 28, post-induction mean arterial pressure, and successful intubation on the first attempt. Using Bayesian random-effects meta-analysis, the risk ratio for mortality was assessed with a neutral prior indicating no difference, estimating an effect size between a relative risk of 0.25 and 4. For mortality reduction, the probability was calculated based on the risk ratio and 95% CI. Secondary outcomes were evaluated using a frequentist random-effects model.
The results showed 7 RCTs and 1 propensity-matched study, totaling 2,978 patients. Etomidate served as the comparator in all identified studies. The probability of ketamine reducing mortality was 83.2% (376 out of 1,475 [25%] vs 411 out of 1503 [27%]; RR, 0.93; 95% CrI, 0.79–1.08), confirmed by subgroup analysis excluding studies with a high risk of bias with no significant differences in any secondary outcomes.
They concluded that ketamine in critically ill intubation patients showed moderate potential for lowering mortality risk compared to other agents.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04831-4