Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Medicine Pub Date : 2024-11-21 DOI:10.1097/CCM.0000000000006515

Alisha Greer, Mark Hewitt, Parsa T Khazaneh, Begum Ergan, Lisa Burry, Matthew W Semler, Bram Rochwerg, Sameer Sharif

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Abstract

Objectives: To compare the safety and efficacy of ketamine and etomidate as induction agents to facilitate emergent endotracheal intubation.

Data sources: We searched MEDLINE, Embase, Cochrane Clinical Trials Register, and ClinicalTrials.gov from inception to April 3, 2024.

Study selection: We included randomized controlled trials (RCTs) that compared ketamine to etomidate to facilitate emergent endotracheal intubation in adults.

Data extraction: Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023472450).

Data synthesis: We included seven RCTs (n = 2384 patients). Based on pooled analysis, compared with etomidate, ketamine probably increases hemodynamic instability in the peri-intubation period (relative risk [RR], 1.29; 95% CI, 1.07-1.57; moderate certainty) but probably decreases the need for initiation of continuous infusion vasopressors (RR, 0.75; 95% CI, 0.57-1.00; moderate certainty) and results in less adrenal suppression (RR, 0.54; 95% CI, 0.45-0.66; moderate certainty). Ketamine probably has no effect on successful intubation on the first attempt (RR, 1.01; 95% CI, 0.97-1.05; moderate certainty) or organ dysfunction measured as the maximum Sequential Organ Failure Assessment (SOFA) score during the first 3 days in ICU (mean difference, 0.55 SOFA points lower; 95% CI, 1.12 lower to 0.03 higher; moderate certainty) and may have no effect on mortality (RR, 1.00; 95% CI, 0.83-1.21; low certainty) when compared with etomidate.

Conclusions: Compared with etomidate, ketamine probably results in more hemodynamic instability during the peri-intubation period and appears to have no effect on successful intubation on the first attempt or mortality. However, ketamine results in decreased need for the initiation of vasopressor use and decreases adrenal suppression compared with etomidate.

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氯胺酮与依托咪酯用于快速顺序插管：随机试验的系统回顾和元分析》。

目的：比较氯胺酮和依托咪酯作为诱导剂促进紧急气管插管的安全性和有效性：比较氯胺酮和依托咪酯作为诱导剂促进紧急气管插管的安全性和有效性：我们检索了从开始到2024年4月3日的MEDLINE、Embase、Cochrane临床试验注册中心和ClinicalTrials.gov：我们纳入了比较氯胺酮与依托咪酯促进成人紧急气管插管的随机对照试验（RCT）：审稿人独立筛选摘要和全文，并一式两份提取数据。我们使用随机效应模型汇总数据，使用修改后的 Cochrane 工具评估偏倚风险，使用分级推荐评估、开发和评价方法评估证据的确定性。我们在 PROSPERO（CRD42023472450）上预先注册了该方案：我们纳入了 7 项 RCT（n = 2384 例患者）。根据汇总分析，与依托咪酯相比，氯胺酮可能会增加插管前后的血流动力学不稳定性（相对风险 [RR]，1.29；95% CI，1.07-1.57；中等确定性），但可能会减少开始持续输注血管加压药的需要（RR，0.75；95% CI，0.57-1.00；中等确定性），并导致较少的肾上腺抑制（RR，0.54；95% CI，0.45-0.66；中等确定性）。氯胺酮可能对首次尝试插管成功率（RR，1.01；95% CI，0.97-1.05；中等确定性）或在重症监护室的前三天内以序贯器官功能衰竭评估（SOFA）最高分衡量的器官功能障碍没有影响（平均差异为 0.与依托咪酯相比，酮康唑对死亡率可能没有影响（RR，1.00；95% CI，0.83-1.21；低确定性）：结论：与依托咪酯相比，氯胺酮可能会在插管前后造成更多的血流动力学不稳定，但似乎对首次插管成功率或死亡率没有影响。不过，与依托咪酯相比，氯胺酮可减少对血管加压药的使用需求，并降低肾上腺抑制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.