Sharda Saurabh C, Bhatia Mandip S
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Crit Care Med. 2022 Jan;26(1):108-113. doi: 10.5005/jp-journals-10071-24086.
The objective of the study was to compare the safety and efficacy of etomidate and ketamine as induction agents for rapid sequence intubation (RSI) in acutely ill patients in emergency department and prehospital settings with respect to post-induction hypotension and first-pass intubation success during RSI.
For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane, and ClinicalTrials.gov between database inception and June 1, 2021. Articles were included if they compared safety and efficacy of etomidate vs ketamine as induction agents, in patients undergoing RSI in emergency department and prehospital settings, without any restrictions on study design. The outcome measures were incidence of post-induction hypotension and first-pass intubation success. The dichotomous outcomes were assessed for odds ratio (OR) with 95% confidence interval (CI) using random-effects meta-analysis.
Of 87 records identified, 9 were eligible, all assessed as having a low to moderate risk of overall bias. Six studies, including 12,060 patients from prehospital emergency medical services, air medical transport, and emergency department settings, compared post-induction hypotension incidence between etomidate and ketamine groups. The meta-analysis showed that etomidate was associated with decreased risk of post-induction hypotension compared to ketamine (OR: 0.53; 95% CI: 0.31-0.91; = 68%). Seven studies, including 15,574 patients, reported on the rate of first-pass intubation success with etomidate vs ketamine. In the pooled analysis, no differences were seen in first-pass intubation success during RSI using etomidate vs ketamine as the induction agent (OR: 1.13; 95% CI: 0.95-1.36; = 16%).
The use of etomidate for induction during RSI is associated with a decreased risk of post-induction hypotension as compared to the use of ketamine, without an impact on the first-pass intubation success rate.
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(1):108-113.
本研究的目的是比较依托咪酯和氯胺酮作为急诊科和院前环境中急性病患者快速顺序诱导插管（RSI）诱导剂时，在诱导后低血压和RSI期间首次插管成功率方面的安全性和有效性。
对于本系统评价和荟萃分析，我们在数据库建立至2021年6月1日期间检索了PubMed、Embase、Cochrane和ClinicalTrials.gov。如果文章比较了依托咪酯与氯胺酮作为诱导剂在急诊科和院前环境中接受RSI患者的安全性和有效性，且对研究设计没有任何限制，则纳入这些文章。结局指标为诱导后低血压的发生率和首次插管成功率。使用随机效应荟萃分析评估二分结局的比值比（OR）及95%置信区间（CI）。
在识别出的87条记录中，9条符合条件，所有记录均被评估为总体偏倚风险低至中度。六项研究，包括来自院前紧急医疗服务、空中医疗运输和急诊科环境的12,060名患者，比较了依托咪酯和氯胺酮组诱导后低血压的发生率。荟萃分析表明，与氯胺酮相比，依托咪酯与诱导后低血压风险降低相关（OR：0.53；95%CI：0.31 - 0.91；P = 68%）。七项研究，包括15,574名患者，报告了依托咪酯与氯胺酮的首次插管成功率。在汇总分析中，使用依托咪酯与氯胺酮作为诱导剂在RSI期间首次插管成功率没有差异（OR：1.13；95%CI：0.95 - 1.36；P = 16%）。
与氯胺酮相比，在RSI期间使用依托咪酯进行诱导与诱导后低血压风险降低相关，且对首次插管成功率没有影响。
Sharda SC, Bhatia MS. 依托咪酯与氯胺酮在快速顺序诱导插管中的诱导作用比较：一项系统评价和荟萃分析。《印度重症监护医学杂志》2022；26(1):108 - 113。
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