SCCM Podcast SCCMPod-550 CCM: Choosing Induction Agents in Critical Care
Oct 2, 2025
Vincenzo Russotto, an Associate Professor of Anesthesiology at the University of Turin, joins to discuss induction agents for tracheal intubation in critically ill patients. He explores the ethical challenges in researching these agents, emphasizing the need for individualized care. The conversation delves into the pros and cons of ketamine, etomidate, and propofol, revealing insights on hemodynamic management. Russotto stresses the importance of tailoring drug choices based on patient needs to improve outcomes during intubation.
AI Snips
Chapters
Transcript
Episode notes
Observational Data Drove Current Questions
- Observational studies drove concern about per-intubation cardiovascular collapse in critically ill patients.
- Randomized trial data are limited and most comparisons focus on ketamine vs etomidate.
Test Hemodynamic Optimization With Vasopressors
- Consider trials testing whether preemptive vasopressors mitigate post-induction cardiovascular collapse.
- Evaluate if pairing propofol with vasopressors could make it as safe as alternatives.
Etomidate Carries A Mortality Signal
- Evidence suggests etomidate may carry a mortality signal possibly linked to adrenal suppression.
- Available randomized data are limited and meta-analyses have flagged potential harm versus alternatives.