Among critically ill patients receiving mechanical ventilation, those given ketamine for emergency tracheal intubation had fewer posttraumatic stress disorder (PTSD) symptoms at 12 months than those given etomidate. PTSD symptoms were measured with the PCL-5 scale (0-80). The median score was 7 for the ketamine group and 14 for the etomidate group. Probable PTSD (score ≥31) occurred in 15.4% of ketamine patients versus 20.2% of etomidate patients. The analysis adjusted for age, race, sex, education, pre-existing depression or PTSD, comorbidities, illness severity, sepsis, and intubation location. These results suggest a protective association but require confirmation in a randomized trial.
Among critically ill adults undergoing emergency tracheal intubation, it is uncertain whether the choice of ketamine or etomidate for induction of anesthesia affects patient outcomes. The Randomized trial of Sedative choice for Intubation (RSI) is a pragmatic, multicenter trial enrolling 2,364 patients across 14 U.S. sites to compare ketamine versus etomidate. The primary outcome is all-cause, 28-day in-hospital mortality; a secondary outcome is cardiovascular collapse during intubation. Enrollment began in April 2022 and is expected to conclude in 2025. Prespecifying the protocol and statistical analysis plan before enrollment ends increases the trial's rigor, reproducibility, and transparency.