SCCMPod-550 CCM: Choosing Induction Agents in Critical Care

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, FCCM, welcomes Vincenzo Russotto, MD, of the University of Turin in Turin, Italy to discuss Dr. Russotto’s article, “Induction Agents for Tracheal Intubation in Critically Ill Patients,” published in the January 2025 issue of Critical Care Medicine. Drs. Enfield and Russotto explore the decision of which induction drugs to use for patients undergoing tracheal intubation. They discuss research challenges such as the ethics of which drugs can be tested on patients and the emergent nature of many tracheal intubations. Dr. Russotto discusses the advantages and disadvantages of ketamine as an induction agent and describes current clinical thinking on etomidate and propofol. His study made no definitive conclusions but found evidence that ketamine may have a safer profile and etomidate and propofol may be associated with negative effects. Dr. Russotto emphasizes the need to individualize patient treatment and shares examples of induction agent combinations. He encourages clinicians to consider hemodynamic optimization along with the use of intubation agents. Listeners will gain insights to inform patient care. Resources referenced in this episode: Induction Agents for Tracheal Intubation in Critically Ill Patients (Kotani Y, et al. Crit Care Med. 2025;53:e173-e181).