Evaluation of Reduced-Dose Induction Agents During Endotracheal Intubation in Critical Care Transport

Induction agent selection and dose are potentially modifiable risk factors to mitigate postintubation hypotension and hemodynamic collapse. Despite it being a common practice, minimal literature exists to support induction agent dose reduction. Our objective was to evaluate the rate of postintubation hemodynamic collapse with reduced-dose compared to full dose induction agents.

This is a retrospective chart review of adult patients who were endotracheally intubated by a critical care transport team and received etomidate or ketamine for induction. The primary outcome was association of reduced-dose induction agent use (etomidate <0.2 mg/kg or ketamine <1 mg/kg) with postintubation hemodynamic collapse.

A total of 304 patients were included; 187 (61.5%) received etomidate and 117 (38.5%) received ketamine. Of these 304 patients, 64 (21.1%) received reduced-dose agents and 240 (78.9%) received full-dose agents. The initial systolic blood pressure and mean arterial blood pressure levels were lower in the reduced-dose arm. Shock index, hemodynamic collapse, and life-threatening hemodynamic collapse did not differ between the groups.

In this analysis, there was no difference in rates of postintubation hemodynamic collapse with reduced-dose induction agents when compared with full-dose agents.