Evaluation of Reduced-Dose Induction Agents During Endotracheal Intubation in Critical Care Transport

Abstract

Objective

Induction agent selection and dose are potentially modifiable risk factors to mitigate postintubation hypotension and hemodynamic collapse. Despite it being a common practice, minimal literature exists to support induction agent dose reduction. Our objective was to evaluate the rate of postintubation hemodynamic collapse with reduced-dose compared to full dose induction agents.

Methods

This is a retrospective chart review of adult patients who were endotracheally intubated by a critical care transport team and received etomidate or ketamine for induction. The primary outcome was association of reduced-dose induction agent use (etomidate <0.2 mg/kg or ketamine <1 mg/kg) with postintubation hemodynamic collapse.

Results

A total of 304 patients were included; 187 (61.5%) received etomidate and 117 (38.5%) received ketamine. Of these 304 patients, 64 (21.1%) received reduced-dose agents and 240 (78.9%) received full-dose agents. The initial systolic blood pressure and mean arterial blood pressure levels were lower in the reduced-dose arm. Shock index, hemodynamic collapse, and life-threatening hemodynamic collapse did not differ between the groups.

Conclusion

In this analysis, there was no difference in rates of postintubation hemodynamic collapse with reduced-dose induction agents when compared with full-dose agents.