Ketamine Does Not Reduce 28-Day Mortality Compared With Etomidate

Tracheal intubation in critically ill adults is a high-risk procedure frequently complicated by severe hypotension and cardiac arrest [1]. For decades, etomidate has been a preferred induction agent due to its reputation for hemodynamic stability, yet its known inhibition of adrenal steroidogenesis (the biological process by which the adrenal glands produce cortisol and other essential hormones) has raised persistent concerns regarding increased mortality [2, 3]. While ketamine is often utilized as an alternative to maintain mean arterial pressure through sympathetic stimulation, its impact on long-term survival remains a subject of active debate [4, 5]. Current clinical practice guidelines emphasize the need for evidence-based sedative choices to mitigate the risks of cardiovascular collapse in the intensive care unit [6, 7]. A recent multicenter randomized trial now provides definitive data to help clinicians navigate this fundamental choice in emergency airway management.