In a single-center retrospective study of 264 mechanically ventilated adults, those intubated in the emergency department took longer to reach light sedation (median 13.5 hours) than those intubated in the intensive care unit (median 10.5 hours). Within 24 hours, 68% of emergency department patients achieved light sedation compared with 82% of intensive care unit patients. Ketamine was used more often for intubation in the emergency department (61% vs 40%), while propofol, benzodiazepines, and fentanyl were used more frequently in the intensive care unit. Patients intubated in the emergency department were 36% less likely to achieve light sedation within 24 hours (adjusted hazard ratio 0.64).
The PROMINE study is a planned randomized trial comparing ketamine and propofol for rapid sequence intubation in critically ill patients. Propofol is commonly used but can worsen low blood pressure, whereas ketamine may be safer due to a more favorable effect on blood pressure. The study will randomly assign 170 critically ill patients needing a breathing tube in the intensive care unit to receive either ketamine or propofol. The main outcome is the occurrence of low blood pressure within the first 10 minutes after drug administration. The results aim to guide which hypnotic agent is safer for these vulnerable patients.