Etomidate or Midazolam for Rapid Sequence Induction in Patients with Suspected Sepsis?

Despite studies showing no increase in adverse outcomes related to etomidate induction for intubation of patients with shock (JW Emerg Med Jul 2 2009 and JW Emerg Med Feb 13 2009), some clinicians still oppose its use in such patients. In this prospective, double-blind, randomized trial, 122 adult patients who presented to a single emergency department with suspected sepsis and indication for intubation received either midazolam (0.1 mg/kg) or etomidate (0.3 mg/kg) for induction. Sepsis was confirmed in 96 patients who had clear evidence of infection and fulfilled two of four criteria for systemic inflammatory response syndrome.

The midazolam and etomidate groups demonstrated no significant differences in median hospital length of stay (LOS)…