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Despite etomidate’s hemodynamic benefits, some clinicians have challenged its use for rapid sequence intubation (RSI) in critically ill patients, citing concerns about adrenal insufficiency (JW Emerg Med Feb 1 2008). In a prospective trial, researchers compared outcomes in 469 adult patients who were randomized to receive a single intravenous bolus of etomidate (0.3 mg/kg) or ketamine (2.0 mg/kg) for induction during RSI at 65 intensive care units (ICUs) and 12 emergency departments or prehospital systems in France. All patients received IV succinylcholine (1 mg/kg) immediately after the trial medication and continuous sedation with midazolam (0.1 mg/kg/hour) combined with fentanyl or sufentanil after tube placement was confirmed.
Final diag…