What clinical features guide your choice between ketamine and etomidate in patients with septic shock who require rapid sequence intubation given recent data suggesting no difference in 28 day mortality?

Given the lower risk for hypotension with use of etomidate vs. ketamine, I usually use etomidate. I find the onset of action is more predictable. In our medical intensive care unit (MICU), the only time I reach for ketamine for rapid sequence intubation (RSI) is if patients have bronchospasms.

For most, short of compelling evidence favoring one medication over another, the choice of induction agent for intubation is influenced by the comfort and familiarity one has with a particular agent. This is likely the case for most, given the recent article demonstrating no mortality difference in ...