Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis

Tracheal intubation is a high-risk intervention commonly performed in critically ill patients. Due to its favorable cardiovascular profile, ketamine is considered less likely to compromise clinical outcomes. This meta-analysis aimed to assess whether ketamine, compared with other agents, reduces mor...

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Published in:Critical care (London, England) England), 2024-02, Vol.28 (1), p.48, Article 48
Main Authors: Koroki, Takatoshi, Kotani, Yuki, Yaguchi, Takahiko, Shibata, Taisuke, Fujii, Motoki, Fresilli, Stefano, Tonai, Mayuko, Karumai, Toshiyuki, Lee, Todd C, Landoni, Giovanni, Hayashi, Yoshiro
Format: Article
Language:English
Subjects:
Adult
Adults
Bayes Theorem
Bias
Care and treatment
Clinical trials
Comparative analysis
Critical Illness - therapy
Critically ill
Data collection
Dosage and administration
Emergency medical care
Etomidate
Etomidate - adverse effects
Humans
Intensive care
Intubation
Intubation, Intratracheal - adverse effects
Ketamine
Ketamine - pharmacology
Ketamine - therapeutic use
Meta-analysis
Mortality
Probability
Sensitivity analysis
Software
Systematic review
Trachea
Ventilators
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Summary:Tracheal intubation is a high-risk intervention commonly performed in critically ill patients. Due to its favorable cardiovascular profile, ketamine is considered less likely to compromise clinical outcomes. This meta-analysis aimed to assess whether ketamine, compared with other agents, reduces mortality in critically ill patients undergoing intubation. We searched MEDLINE, Embase, and the Cochrane Library from inception until April 27, 2023, for randomized controlled trials and matched observational studies comparing ketamine with any control in critically ill patients as an induction agent. The primary outcome was mortality at the longest follow-up available, and the secondary outcomes included 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. For the primary outcome, we used a Bayesian random-effects meta-analysis on the risk ratio (RR) scale with a weakly informative neutral prior corresponding to a mean estimate of no difference with 95% probability; the estimated effect size will fall between a relative risk of 0.25 and 4. The RR and 95% credible interval (CrI) were used to estimate the probability of mortality reduction (RR 
ISSN:1364-8535
1466-609X
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-024-04831-4