Induction for rapid sequence intubation (RSI) in the critically ill often feels like the swing of a pendulum. Toward etomidate—haemodynamic poise, clean hypnosis, and familiar dosing. Back toward ketamine—sympathomimetic support, bronchodilation, and neuro-myths in slow retreat. The science, at times, looks just as mercurial. This review examines the terrain with a steady eye: what goes wrong when we intubate the critically ill; why physiology, not just anatomy, governs risk; what etomidate and ketamine truly offer; what the best comparative trials show; and where ongoing research is taking the field.

Added September 4th

We review the RE-ENERGIZE trial, investigating glutamine for patient's with severe burns, and seek to understand why the trial failed to identify benefit. Was it a methodological failure, a flawed execution, or a correct identification of a non-beneficial intervention?

Added December 20th, 2023

The Fragility Index is the minimum number of subjects whose status would have to change from a non-event to an event to convert a statistically significant result of the trial into a non-significant result. It is an expression of the study characteristics, and not of validity.

Guest post by Dr Ed Palmer

Added August 21st, 2022

Why did the REST trial¹ fail to clearly demonstrate benefit with the addition of an ECCO₂R  device in invasively mechanically ventilated patients with acute hypoxaemic respiratory failure?

Added October 4th, 2021