title: Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: A propensity matched analysis.
abstract: This study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation.
  
  
  
  This single-center, retrospective propensity-matched cohort study included septic patients admitted to our medical intensive care unit who received either etomidate or ketamine for intubation. Clinical hypotension was defined as any one of the following: mean arterial pressure (MAP) decrease >40% compared to baseline and MAP <70 mmHg, MAP <60 mmHg, initiation of a vasopressor, or increase to >30% of the initial vasopressor dose.
  
  
  
  Patients were matched based on propensity scores determined by demographics and baseline characteristics. A total of 384 (200 etomidate and 184 ketamine) patients were included for analysis with 230 patients (115 in each group) matched. Clinical hypotension was less prevalent in patients who received ketamine as compared to etomidate [51.3% vs. 73% (odds ratio=0.39, 95% confidence interval=0.22-0.67, P=.001]. The etomidate group experienced significantly lower MAPs at time periods 6.1-12 hours (65.1 mmHg vs. 69.3 mmHg, P=.01) and 12.1-24 hours (63.9 mmHg vs. 68.4 mmHg, P=.003).
  
  
  
  Ketamine was associated with a lower incidence of clinical hypotension within the 24 hour period following endotracheal intubation in septic patients.
authors.affiliation: Department of Pharmacy, Methodist LeBohneur Healthcare- University Hospital, 1265 Union Ave., Memphis, TN 38104. Electronic address: Megan.VanBerkel@mlh.org.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Van Berkel
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, 201 Davis Heart & Lung Research Institute, 473 West 12th Ave, Columbus, OH 43210. Electronic address: Matthew.exline@osumc.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Exline
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, 410 W. 10th Ave, Columbus, OH 43204. Electronic address: Kari.cape@osumc.edu.
authors.forename: Kari M
authors.initials: KM
authors.lastname: Cape
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, 410 W. 10th Ave, Columbus, OH 43204. Electronic address: Lindsay.ryder@osumc.edu.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Ryder
authors.affiliation: The Ohio State University Center for Biostatistics, 2012 Kenny Road, Columbus, OH 43221. Electronic address: Gary.Phillips@osumc.edu.
authors.forename: Gary
authors.initials: G
authors.lastname: Phillips
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 West 12th Ave, Columbus, OH 43210. Electronic address: Naeem.ali@osumc.edu.
authors.forename: Naeem A
authors.initials: NA
authors.lastname: Ali
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, 410 W. 10th Ave, Columbus, OH 43204. Electronic address: Bruce.doepker@osumc.edu.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Doepker
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology*; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D057216:Propensity Score; D012189:Retrospective Studies; D018805:Sepsis
chemical_list: D018686:Anesthetics, Intravenous; D007649:Ketamine; D005045:Etomidate
keywords: Critically ill; Etomidate; Hypotension; Intubation; Ketamine; Sepsis