Rapid Sequence Intubation in the Critically Ill Adult Patient

Publication Date: September 14, 2023
Last Updated: September 29, 2023

Summary of Recommendations

We recommend administering an NMBA when a sedative-hypnotic induction agent is used for intubation. (S, L)

We suggest there is no difference between etomidate and other induction agents administered for RSI with respect to mortality or the incidence of hypotension or vasopressor use in the peri-intubation period and through hospital discharge. (C, M)

We suggest preoxygenation with HFNO when laryngoscopy is expected to be challenging. (C, L)

We suggest preoxygenation with NIPPV in patients with severe hypoxemia Pao2/Fio2 of less than 150. (C, L)

We suggest administering either rocuronium or succinylcholine for RSI when there are no known contraindications to succinylcholine. (C, L)

Recommendation Grading


  • HFNO: High-flow Nasal Oxygen
  • NIPPV: Noninvasive Positive Pressure Ventilation
  • NMBA: Neuromuscular-blocking Agent
  • RSI: Rapid Sequence Intubation


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Rapid Sequence Intubation in the Critically Ill Adult Patient

Authoring Organization

Publication Month/Year

September 14, 2023

Last Updated Month/Year

November 6, 2023

Document Type


Country of Publication


Document Objectives

Develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI

Target Patient Population

Critically ill adult patients

Target Provider Population

Critical care, anesthesiology, emergency medicine, internal medicine, and other allied providers caring for critically ill adult patients in need of rapid intubation

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist


Treatment, Management

Diseases/Conditions (MeSH)

D016638 - Critical Illness, D007440 - Intubation, D000079603 - Rapid Sequence Induction and Intubation


critically ill, intubation, rapid sequence intubation, RSI

Source Citation

Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck TP, Chase K, Heffner AC, Gunnerson KJ, Boling B, Murray MJ. Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient: Executive Summary. Crit Care Med. 2023 Oct 1;51(10):1407-1410. doi: 10.1097/CCM.0000000000005999. Epub 2023 Sep 14. PMID: 37707378.

Supplemental Methodology Resources

Data Supplement