The Case for Etomidate, Steroid Safety in Pneumonia, and RSV’s Link to Childhood Asthma

From Featured Buzz, December 15, 2025

Etomidate May Be Safer Than Ketamine During Intubation
A new study published in The New England Journal of Medicine suggests that etomidate may be a better sedative for patients undergoing endotracheal intubation than ketamine.

The finding comes from investigators at Vanderbilt University Medical Center and elsewhere who conducted a randomized trial involving 2,365 patients in 14 U.S. emergency departments and ICUs. About half of the patients were intubated using ketamine, and the other half were intubated using etomidate.

The use of etomidate significantly decreased the risk of dangerously low blood pressures during the procedure when compared with ketamine without any impact on the risk of death.

“We found that etomidate is safe and that ketamine can cause severely low blood pressure during intubation,” said study author Matthew Semler, MD, MSCI. ”Going forward, many clinicians will choose to use etomidate rather than ketamine.”

The study results may be especially meaningful in countries where etomidate has been removed from the market in favor of ketamine.

Dr. Semler also notes that, while both drugs have been in use for decades, this is the first large, multicenter trial to compare outcomes between the two, reinforcing the need to continue studying medications given to patients, even those that have been on the market for years.

“These findings emphasize why more research must focus not just on the development of new drugs and devices, but also on understanding which treatments patients are already receiving produce the best outcomes,” concluded Dr. Semler.

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Systemic Corticosteroids Probably Don’t Raise Risk for Infectious Complications in Severe Pneumonia, ARDS
Clinicians have long worried about the risk of infectious complications with the use of systemic corticosteroids for pneumonia and ARDS, but a new study suggests that worry is unfounded.

French researchers who analyzed data from 20 randomized controlled trials involving 3,459 patients found that systemic corticosteroids do not increase the risk of infectious complications in patients with non-COVID-19 pneumonia or ARDS.

The study also revealed:

• Adjunct corticosteroids most likely reduce short-term mortality in both severe pneumonia and ARDS, but evidence for their effect on long-term mortality remains uncertain.
• In severe pneumonia, corticosteroids may reduce secondary shock, but they have little effect on hospital-acquired infections and secondary pneumonia in both severe pneumonia and ARDS.
• The evidence is very uncertain about the effect of corticosteroids on catheter-related infections in both conditions.

The studies included in the meta-analysis compared systemic corticosteroids with placebo and usual care in patients receiving 3 mg/kg or less per day for 15 days or less, initiated within seven days of pneumonia or ARDS onset.

“In severe pneumonia and ARDS, adjunct corticosteroids probably reduce short-term mortality,” wrote the authors. “In severe pneumonia, they may reduce secondary shock. In both conditions, corticosteroids may have little or no effect on hospital-acquired infections.”

The study was published in the Annals of Internal Medicine.

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The Key to Preventing Asthma May Be Preventing RSV
Could protecting newborns from getting RSV help protect them from developing asthma as well? European researchers publishing in Science Immunology believe this may be the case.

They uncovered the link by combining nationwide health information on all children in Denmark and their parents with results from controlled laboratory studies in mice, specifically examining how RSV infection affects immune responses to allergy triggers.

The population study showed that infants who were hospitalized with RSV bronchiolitis and who had parents with allergic asthma were more likely to go on to develop asthma.

Results from the laboratory study in mice showed that infants who developed a severe RSV infection soon after birth were more likely to develop immune responses that overreact to common allergens, including house dust mites. This tendency was strongest in those with mothers who had a house dust mite allergy.

However, the increased risk was mitigated when the newborn mice were given RSV immunoprophylaxis. By preventing the development of allergies, the authors believe asthma may also be prevented.

“With RSV prevention now becoming widely accessible, we have an opportunity to improve long-term respiratory health, not just prevent RSV hospitalizations,” said study author Hamida Hammad, from Ghent University. “This is not just a laboratory insight. It’s a message that should help parents choose RSV prevention with confidence.”

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