SCCM Podcast SCCMPod-550 CCM: Choosing Induction Agents in Critical Care
Oct 2, 2025
Vincenzo Russotto, an Associate Professor of Anesthesiology and Intensive Care at the University of Turin, shares his expertise on induction agents for tracheal intubation in critically ill patients. He discusses the pros and cons of ketamine, etomidate, and propofol, highlighting recent findings suggesting ketamine may offer a safer profile. Ethical challenges in testing these drugs and the importance of hemodynamic optimization during intubation are emphasized. Russotto advocates for personalized treatment approaches based on individual patient conditions.
AI Snips
Chapters
Transcript
Episode notes
Evidence Is Mostly Observational
- Observational studies drove awareness of high perintubation adverse events, especially cardiovascular collapse.
- Randomized trial evidence is limited and many comparisons, beyond ketamine vs etomidate, are missing.
Test Hemodynamic Optimization With Drugs
- Consider trials that test hemodynamic optimization (eg, preemptive vasopressors) alongside induction drugs.
- Such trials could reveal whether propofol plus vasopressor is as safe as other agents.
Etomidate Carries A Mortality Signal
- Etomidate has signals of harm from a single RCT and meta-analyses suggesting increased mortality.
- Biological plausibility exists via adrenal enzyme suppression (11-beta-hydroxylase inhibition).