Literature Review: Rapid Sequence Intubation

Guidelines

• SCCM Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient
  • We suggest there is no difference between etomidate and other induction agents administered for RSI with respect to mortality or the incidence of hypotension or vasopressor use in the peri-intubation period and through hospital discharge.
    • Quality of Evidence: Moderate Strength of Recommendation: Conditional
  • We suggest against administering corticosteroids following RSI with etomidate for the purpose of counteracting etomidate-induced adrenal suppression.
    • Quality of Evidence: Low
    • Strength of Recommendation: Conditional
  • We recommend administering an NMBA when a sedative-hypnotic induction agent is used for intubation.
    • Quality of Evidence: Low
    • Strength of Recommendation: Strong
  • We suggest administering either rocuronium or succinylcholine for RSI when there are no known contraindications to succinylcholine.
    • Quality of Evidence: Low
    • Strength of Recommendation: Conditional
  • There is insufficient evidence to make a recommendation that there is a difference in the incidence of further hypotension or cardiac arrest between the administration of peri-intubation vasopressors or IV fluids for hypotensive critically ill patients undergoing RSI.
    • Insufficient evidence
  • We advise administering a sedative-hypnotic induction agent when an NMBA is used for intubation.
    

• Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review.

• Propofol, Ketamine, and Etomidate as Induction Agents for Intubation and Outcomes in Critically Ill Patients: A Retrospective Cohort Study.

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