UpToDate®

UpToDate® and Emergency Medicine News are collaborating to present select newly released UpToDate Emergency Medicine content synopses, such as the examples below. UpToDate is the premier evidence-based, clinical support resource used by emergency medicine professionals and healthcare practitioners worldwide to make informed clinical decisions at the point of care. Please note that the examples below are accurate as of the month/year indicated next to each topic excerpt. To ensure you are accessing the most current clinical information, subscribe to UpToDate. For a limited time, you can receive an additional 30 days added to an annual or longer personal subscription term when you visit go.uptodate.com/emn and enter promo code EMN30. This offer is valid through February 28, 2026. Induction and tracheal intubation in critically ill patients using etomidate or ketamine (December 2025) Concern exists regarding induction with etomidate during rapid sequence intubation (RSI) in critically ill patients, particularly septic patients, because of transient adrenocortical suppression that may worsen outcomes. Ketamine has been proposed as an alternative for such patients, but it stimulates catecholamine release and may increase risk of myocardial ischemia or pulmonary hypertension. A pragmatic trial of more than 2300 critically ill adults undergoing RSI in the emergency department or intensive care unit found similar in-hospital 28-day mortality between the ketamine and etomidate groups (28 versus 29 percent).1 Almost half of the patients had sepsis or septic shock, also with no difference in mortality (39 versus 38 percent). These findings suggest that either etomidate or ketamine is a reasonable induction agent in critically ill patients, including those with sepsis.