Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults.

Whether the use of ketamine rather than etomidate decreases the risk of death is uncertain.

使用氯胺酮而非依托咪酯是否能降低死亡风险尚不明确。

Methods

In a randomized trial conducted in 14 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults who were undergoing tracheal intubation to receive ketamine or etomidate for the induction of anesthesia.

在美国的14个急诊科和重症监护室进行的一项随机试验中，我们随机分配了正在接受气管插管的危重病成人患者，以接受氯胺酮或依托咪酯进行麻醉诱导。

The primary outcome was in-hospital death from any cause by day 28.

主要结果是在第28天因任何原因导致的院内死亡。

The secondary outcome was cardiovascular collapse during intubation, defined by the occurrence of a systolic blood pressure below 65 mm Hg, receipt of a new or increased dose of vasopressors, or cardiac arrest.

次要结果是在插管期间发生的心血管崩溃，定义为收缩压低于65毫米汞柱，接受新的或增加剂量的血管加压药物，或心脏骤停。

Results

A total of 2365 patients underwent randomization and were included in the trial population; 1176 were assigned to the ketamine group and 1189 to the etomidate group.

共有2365名患者进行了随机分组并被纳入试验人群；1176名被分配到氯胺酮组，1189名被分配到依托咪酯组。

In-hospital death by day 28 occurred in 330 of 1173 patients (28.1%) in the ketamine group and in 345 of 1186 patients (29.1%) in the etomidate group (risk difference adjusted for trial site, -0.8 percentage points; 95% confidence interval[CI], -4.5 to 2.9; P = 0.65).

在入院后第28天，1173名患者中有330名（28.1%）在氯胺酮组发生院内死亡，而在1186名患者中有345名（29.1%）在依托咪酯组发生院内死亡（校正试验地点的风险差异为-0.8个百分点；95%置信区间[CI]，-4.5至2.9；P = 0.65）。

Cardiovascular collapse during intubation occurred in 260 of 1176 patients (22.1%) in the ketamine group and in 202 of 1189 patients (17.0%) in the etomidate group (risk difference, 5.1 percentage points; 95% CI, 1.9 to 8.3).

在插管期间，1176名患者中有260名（22.1%）在氯胺酮组发生心血管崩溃，而在1189名患者中有202名（17.0%）在依托咪酯组发生心血管崩溃（风险差异为5.1个百分点；95%置信区间[CI]，1.9至8.3）。

Prespecified safety outcomes were similar in the two groups.

两组的预定安全结果相似。

Conclusions

Among critically ill adults undergoing tracheal intubation, the use of ketamine to induce anesthesia did not result in a significantly lower incidenceof in-hospital death by day 28 than etomidate.

在进行气管插管的危重成人中，使用氯胺酮诱导麻醉与使用依托咪酯相比，并没有显著降低28天内院内死亡的发生率。

(Funded by the Patient-Centered Outcomes Research Institute and others; RSI ClinicalTrials.gov number, NCT05277896.).

(由患者为中心的结果研究学会和其他机构资助; RSI ClinicalTrials.gov编号, NCT05277896.)