| Methods |
RCT comparing etomidate (n = 16) and midazolam (n = 15) |
| Participants |
Adult patients requiring intubation in a tertiary care emergency department |
| Interventions |
Etomidate 0.3 mg/kg versus midazolam 0.05 to 0.1 mg/kg |
| Outcomes |
Primary: ACTH Stimulation tests at 4, 12 and 24 hours after intervention. Secondary: mortality, random serum cortisol levels (at 4, 12, and 24 h), hospital LOS2, ICU LOS2, ventilator duration |
| Notes |
|
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Low risk |
Computer generated randomization table |
| Allocation concealment (selection bias) |
High risk |
No description of allocation concealment reported. However, with the lack of blinding, in the setting of significant incomplete data (9 of 31 patients), the reviewers have considerable concern regarding the allocation concealment |
| Incomplete outcome data (attrition bias)
Mortality |
High risk |
9 of 31 enrolled patients have incomplete data, and were excluded from analysis. Effects on risk estimates unclear, although could be substantial; risk of bias high |
| Incomplete outcome data (attrition bias)
Adrenal Gland Dysfunction |
High risk |
9 of 31 enrolled patients have incomplete data, and were excluded from analysis. Effects on risk estimates unclear, although could be substantial; risk of bias high |
| Incomplete outcome data (attrition bias)
Hospital LOS |
High risk |
9 of 31 enrolled patients have incomplete data, and were excluded from analysis. Effects on risk estimates unclear, although could be substantial; risk of bias high |
| Incomplete outcome data (attrition bias)
ICU LOS |
High risk |
9 of 31 enrolled patients have incomplete data, and were excluded from analysis. Effects on risk estimates unclear, although could be substantial; risk of bias high |
| Incomplete outcome data (attrition bias)
Duration of mechanical Ventillation |
High risk |
9 of 31 enrolled patients have incomplete data, and were excluded from analysis. Effects on risk estimates unclear, although could be substantial; risk of bias high |
| Incomplete outcome data (attrition bias)
Vasopressor requirements |
Low risk |
N/A |
| Incomplete outcome data (attrition bias)
Organ Dysfunction |
Low risk |
N/A |
| Incomplete outcome data (attrition bias)
All outcomes |
High risk |
9 of 31 enrolled patients have incomplete data, and were excluded from analysis. Effects on risk estimates unclear, although could be substantial; risk of bias high |
| Selective reporting (reporting bias) |
Low risk |
All relevant data reported |
| Blinding of participants and personnel (performance bias)
All outcomes |
High risk |
Unblinded, and in the setting of a significant proportion of patients excluded due to incomplete data, the reviewers have considerable concern that the unblinded nature of this study has led to bias in risk estimates |
| Blinding of outcome assessment (detection bias)
All outcomes |
High risk |
Unblinded, and in the setting of a significant proportion of patients excluded due to incomplete data, the reviewers have considerable concern that the unblinded nature of this study has led to bias in risk estimates |
