{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:37:30Z","timestamp":1792143450443,"version":"4.4.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Fonds de recherche du Qu\u00e9bec \u2013 Sant\u00e9"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>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\u2009&lt;\u20091). The secondary outcomes were assessed with a frequentist random-effects model. We registered this study in Open Science Framework (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/2vf79\/\">https:\/\/osf.io\/2vf79\/<\/jats:ext-link>).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We included seven randomized trials and one propensity-matched study totaling 2978 patients. Etomidate was the comparator in all the identified studies. The probability that ketamine reduced mortality was 83.2% (376\/1475 [25%] vs. 411\/1503 [27%]; RR, 0.93; 95% CrI, 0.79\u20131.08), which was confirmed by a subgroup analysis excluding studies with a high risk of bias. No significant difference was observed in any secondary outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>All of the included studies evaluated ketamine versus etomidate among critically ill adults requiring tracheal intubation. This meta-analysis showed a moderate probability that induction with ketamine is associated with a reduced risk of mortality.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1186\/s13054-024-04831-4","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T12:02:13Z","timestamp":1708171333000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis"],"prefix":"10.1186","volume":"28","author":[{"given":"Takatoshi","family":"Koroki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kotani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiko","family":"Yaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisuke","family":"Shibata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoki","family":"Fujii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fresilli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuko","family":"Tonai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Karumai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Landoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiro","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"key":"4831_CR1","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1007\/s00134-009-1717-8","volume":"36","author":"S Jaber","year":"2010","unstructured":"Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36:248\u201355.","journal-title":"Intensive Care Med"},{"key":"4831_CR2","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1001\/jama.2021.1727","volume":"325","author":"V Russotto","year":"2021","unstructured":"Russotto V, Myatra SN, Laffey JG, Tassistro E, Antolini L, Bauer P, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. JAMA. 2021;325:1164\u201372.","journal-title":"JAMA"},{"key":"4831_CR3","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.bja.2017.10.021","volume":"120","author":"A Higgs","year":"2018","unstructured":"Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120:323\u201352.","journal-title":"Br J Anaesth"},{"key":"4831_CR4","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13613-019-0483-1","volume":"9","author":"H Quintard","year":"2019","unstructured":"Quintard H, l\u2019Her E, Pottecher J, Adnet F, Constantin J-M, De Jong A, et al. Experts\u2019 guidelines of intubation and extubation of the ICU patient of French society of anaesthesia and intensive care medicine (SFAR) and French-speaking intensive care society (SRLF). Ann Intensive Care. 2019;9:13.","journal-title":"Ann Intensive Care"},{"key":"4831_CR5","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1164\/rccm.202111-2575OC","volume":"206","author":"V Russotto","year":"2022","unstructured":"Russotto V, Tassistro E, Myatra SN, Parotto M, Antolini L, Bauer P, et al. Peri-intubation cardiovascular collapse in patients who are critically ill: insights from the INTUBE study. Am J Respir Crit Care Med. 2022;206:449\u201358.","journal-title":"Am J Respir Crit Care Med"},{"key":"4831_CR6","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1053\/j.jvca.2021.01.034","volume":"35","author":"AA Dalia","year":"2021","unstructured":"Dalia AA, Raines DE. Etomidate and adrenocortical suppression: Should we take the concerns to heart? J Cardiothorac Vasc Anesth. 2021;35:1086\u20138.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"4831_CR7","doi-asserted-by":"publisher","first-page":"154317","DOI":"10.1016\/j.jcrc.2023.154317","volume":"77","author":"Y Kotani","year":"2023","unstructured":"Kotani Y, Piersanti G, Maiucci G, Fresilli S, Turi S, Montanaro G, et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. J Crit Care. 2023;77:154317.","journal-title":"J Crit Care"},{"key":"4831_CR8","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.","journal-title":"BMJ"},{"key":"4831_CR9","doi-asserted-by":"publisher","first-page":"e060972","DOI":"10.1136\/bmjopen-2022-060972","volume":"12","author":"RK Kayambankadzanja","year":"2022","unstructured":"Kayambankadzanja RK, Schell CO, Gerdin W\u00e4rnberg M, Tamras T, Mollazadegan H, Holmberg M, et al. Towards definitions of critical illness and critical care using concept analysis. BMJ Open. 2022;12:e060972.","journal-title":"BMJ Open"},{"key":"4831_CR10","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.","journal-title":"BMJ"},{"key":"4831_CR11","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","volume":"355","author":"JAC Sterne","year":"2016","unstructured":"Sterne JAC, Hern\u00e1n MA, Reeves BC, Savovi\u0107 J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.","journal-title":"BMJ"},{"key":"4831_CR12","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","volume":"336","author":"GH Guyatt","year":"2008","unstructured":"Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924\u20136.","journal-title":"BMJ"},{"key":"4831_CR13","unstructured":"McMaster University (developed by Evidence Prime). GRADEpro GDT 2015."},{"key":"4831_CR14","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","volume":"22","author":"JL Vincent","year":"1996","unstructured":"Vincent JL, Moreno R, Takala J, Willatts S, De Mendon\u00e7a A, Bruining H, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction\/failure. Intensive Care Med. 1996;22:707\u201310.","journal-title":"Intensive Care Med"},{"key":"4831_CR15","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1164\/rccm.202006-2381CP","volume":"203","author":"FG Zampieri","year":"2021","unstructured":"Zampieri FG, Casey JD, Shankar-Hari M, Harrell FE Jr, Harhay MO. Using Bayesian methods to augment the interpretation of critical care trials. An overview of theory and example reanalysis of the alveolar recruitment for acute respiratory distress syndrome trial. Am J Respir Crit Care Med. 2021;203:543\u201352.","journal-title":"Am J Respir Crit Care Med"},{"key":"4831_CR16","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1002\/sim.6381","volume":"34","author":"RM Turner","year":"2015","unstructured":"Turner RM, Jackson D, Wei Y, Thompson SG, Higgins JPT. Predictive distributions for between-study heterogeneity and simple methods for their application in Bayesian meta-analysis. Stat Med. 2015;34:984\u201398.","journal-title":"Stat Med"},{"key":"4831_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v093.i06","volume":"93","author":"C R\u00f6ver","year":"2020","unstructured":"R\u00f6ver C. Bayesian random-effects meta-analysis using the bayesmeta R package. J Stat Softw. 2020;93:1\u201351.","journal-title":"J Stat Softw"},{"key":"4831_CR18","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/S0140-6736(10)60446-1","volume":"376","author":"NK Adhikari","year":"2010","unstructured":"Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376:1339\u201346.","journal-title":"Lancet"},{"key":"4831_CR19","unstructured":"The Cochrane Collaboration. Review Manager (RevMan) version 5.4. 2020."},{"key":"4831_CR20","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/j.jclinepi.2007.10.007","volume":"61","author":"J Brok","year":"2008","unstructured":"Brok J, Thorlund K, Gluud C, Wetterslev J. Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol. 2008;61:763\u20139.","journal-title":"J Clin Epidemiol"},{"key":"4831_CR21","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/S0140-6736(09)60949-1","volume":"374","author":"P Jabre","year":"2009","unstructured":"Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374:293\u2013300.","journal-title":"Lancet"},{"key":"4831_CR22","first-page":"4","volume":"18","author":"CD Punt","year":"2014","unstructured":"Punt CD, Dormans TPJ, Oosterhuis WP, Boer W, Depoorter B, van der Linden CJ, et al. Etomidate and S-ketamine for the intubation of patients on the intensive care unit: a prospective, open-label study. Neth J Crit Care. 2014;18:4\u20137.","journal-title":"Neth J Crit Care"},{"key":"4831_CR23","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1097\/TA.0000000000002448","volume":"87","author":"NJ Smischney","year":"2019","unstructured":"Smischney NJ, Nicholson WT, Brown DR, Gallo De Moraes A, Hoskote SS, Pickering B, et al. Ketamine\/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE Randomized clinical trial. J Trauma Acute Care Surg. 2019;87:883\u201391.","journal-title":"J Trauma Acute Care Surg"},{"key":"4831_CR24","unstructured":"Ketamine Versus Etomidate for Rapid Sequence Intubation [Internet]. 2019 [cited 2023 Aug 13]. Available from: https:\/\/classic.clinicaltrials.gov\/ct2\/show\/results\/NCT01823328"},{"key":"4831_CR25","unstructured":"Powers WF. Evaluating the Hemodynamic Effects of Ketamine Versus Etomidate During Rapid Sequence Intubation (Ket-RSI) [Internet]. 2021. Available from: https:\/\/clinicaltrials.gov\/ct2\/show\/study\/NCT03545503"},{"key":"4831_CR26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1007\/s00134-021-06577-x","volume":"48","author":"G Matchett","year":"2022","unstructured":"Matchett G, Gasanova I, Riccio CA, Nasir D, Sunna MC, Bravenec BJ, et al. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022;48:78\u201391.","journal-title":"Intensive Care Med"},{"key":"4831_CR27","doi-asserted-by":"publisher","first-page":"6362","DOI":"10.1038\/s41598-023-33679-x","volume":"13","author":"W Srivilaithon","year":"2023","unstructured":"Srivilaithon W, Bumrungphanithaworn A, Daorattanachai K, Limjindaporn C, Amnuaypattanapon K, Imsuwan I, et al. Clinical outcomes after a single induction dose of etomidate versus ketamine for emergency department sepsis intubation: a randomized controlled trial. Sci Rep. 2023;13:6362.","journal-title":"Sci Rep"},{"key":"4831_CR28","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.jcrc.2016.11.009","volume":"38","author":"MA Van Berkel","year":"2017","unstructured":"Van Berkel MA, Exline MC, Cape KM, Ryder LP, Phillips G, Ali NA, et al. Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: a propensity matched analysis. J Crit Care. 2017;38:209\u201314.","journal-title":"J Crit Care"},{"key":"4831_CR29","doi-asserted-by":"publisher","first-page":"108","DOI":"10.5005\/jp-journals-10071-24086","volume":"26","author":"SC Sharda","year":"2022","unstructured":"Sharda SC, Bhatia MS. Etomidate compared to ketamine for induction during rapid sequence intubation: a systematic review and meta-analysis. Indian J Crit Care Med. 2022;26:108\u201313.","journal-title":"Indian J Crit Care Med"},{"key":"4831_CR30","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1097\/CCM.0000000000006000","volume":"51","author":"NM Acquisto","year":"2023","unstructured":"Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, et al. Society of critical care medicine clinical practice guidelines for rapid sequence intubation in the critically ill adult patient. Crit Care Med. 2023;51:1411\u201330.","journal-title":"Crit Care Med"},{"key":"4831_CR31","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s00213-008-1377-3","volume":"203","author":"M Blagrove","year":"2009","unstructured":"Blagrove M, Morgan CJA, Curran HV, Bromley L, Brandner B. The incidence of unpleasant dreams after sub-anaesthetic ketamine. Psychopharmacology. 2009;203:109\u201320.","journal-title":"Psychopharmacology"}],"container-title":["Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-024-04831-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13054-024-04831-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-024-04831-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T12:04:26Z","timestamp":1708171466000},"score":1,"resource":{"primary":{"URL":"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-024-04831-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,17]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4831"],"URL":"https:\/\/doi.org\/10.1186\/s13054-024-04831-4","relation":{},"ISSN":["1364-8535"],"issn-type":[{"value":"1364-8535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,17]]},"assertion":[{"value":"14 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"48"}}