Ketamine vs Etomidate in Septic Patients

Written by Clay Smith

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Ketamine was associated with nearly 3 times greater odds of post-intubation hypotension in septic patients when compared with etomidate.

Why does this matter?
We learned yesterday that all-comers had more hypotension when ketamine vs etomidate was used for induction. This threatens the sacred dogma that ketamine is safer, more hemodynamically stable, and should actually raise the blood pressure! Certainly ketamine must be better in septic patients, right?

Ketamine’s magical powers under assault!
Using the National Emergency Airway Registry (NEAR) data, 531 patients with sepsis were intubated, 71% (n=363) with etomidate for induction, 27% (n=140) with ketamine. When comparing ketamine vs etomidate, the odds for post-intubation hypotension was nearly 3 times greater in patients who received ketamine, 74 vs. 50%, OR 2.9 (95%CI 1.9-4.5). Even with statistical adjustment, the aOR was 2.7. There was no difference in short-term, ED mortality.

Source
Etomidate Use is Associated with Less Hypotension Than Ketamine for Emergency Department Sepsis Intubations: A NEAR Cohort Study. Acad Emerg Med. 2020 Jun 30. doi: 10.1111/acem.14070. [Epub ahead of print]

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