A meta-analysis including 7 randomized trials and 1 observational study with a total of 2978 critically ill adult patients compared ketamine and etomidate as sedatives for tracheal intubation. Results showed a modest reduction in mortality with ketamine (25%) compared with etomidate (27%), although the difference was not statistically significant (RR 0.93; 95% CI 0.79–1.08)[1]. A national randomized trial of RSI with 2365 patients confirmed that etomidate does not increase the risk of death and reduces the incidence of dangerously low blood pressure during intubation compared to ketamine, which was associated with a higher risk of cardiovascular complications, especially a severe drop in blood pressure[2][4]. Mortality was similar in this study: 28.1% with ketamine and 29.1% with etomidate[4]. Previous concerns about an increase in intracranial pressure with ketamine have not been confirmed, but trauma patients had a slightly higher, although not statistically significant, mortality with ketamine compared to etomidate[3]. In contrast, a non-statistical trend towards better survival with ketamine was observed in patients with sepsis, probably due to possible etomidate-induced adrenal insufficiency[3]. Both drugs have a favorable hemodynamic profile compared to other sedatives, but ketamine can cause negative cardiac effects in patients with significant cardiac dysfunction or catecholamine depletion[5]. Overall, however, the available evidence did not demonstrate a clear advantage or disadvantage of either drug for tracheal intubation of critically ill patients[1][5].