Presented by Dr TAM Oi Yan Jackie at the Daily Journal Club of ICU, Pamela Youde Nethersole Eastern Hospital, Hong Kong, on 7 July 2009
In the article "Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial, The Lancet, Early Online Publication, 1 July 2009 by Patricia Jabre et al, on behalf of the KETASED Collaborative Study Group", Etomidate (N=234) vs Ketamine (N=235) were compared for use in emergency intubation. The primary endpoint was the maximum score of the sequential organ failure assessment during the first 3 days in the intensive care unit. Which of the following is not found?
A. Overall, the mean maximum SOFA score between the two groups did not differ significantly.
B. More adrenal insufficiency was found in the etomidate group as defined by the ACTH stimulation test.
C. In the subgroup of septic patients, the mortality at D28 was statistically higher.
D. The analysis was a modified intention-to-treat one in that they excluded, after randomisation, patients who were discharged alive from the ICU within 3 days, and patients who died before reaching the hospital.
Answer: C
In the subgroup of septic patient, there was a statistically non-significant trend that the D28 mortality was higher in the etomidate group. However, the authors cautioned that their study was not powered to detect such difference (type II error). Therefore, they proposed that a future study be carried out on patients with sepsis only.