Induction Agent Choice With Early Mortality and Prognostic Outcomes in Critically Ill Patients

Association of Induction Agent Choice With Early Mortality and Prognostic Outcomes in Critically Ill Patients: A Large-Scale Retrospective Cohort Analysis

The aim of this retrospective cohort study is to compare the safety and efficacy of induction agents for tracheal intubation in critically ill adult patients.

Study Overview

• Status: Recruiting
• Conditions: Airway Management; Critically Ill; Ketamine; Intubation Complication; Propofol; Oxygenation
• Intervention / Treatment: Procedure: induction type for intubation in ICU

Detailed Description

Endotracheal intubation is an accepted procedure to optimize oxygenation and ventilation and reduce the risk of aspiration for critically ill patients, essential for their management and survival across various settings, including prehospital care, emergency departments (EDs), and intensive care units (ICUs). Despite advancements, peri-intubation complications and hemodynamic instability, which are associated with increased mortality rates, remain a concern. These risks are exacerbated by pathophysiological factors in critically ill patients compared to those undergoing intubation in surgical settings .

A recent international, multicentre, prospective cohort (INTUBE) study of 2964 critically ill patients undergoing tracheal intubation in the ICU, emergency department, or inpatient wards in 29 countries across five continents reported that the most frequently used agents for induction were Propofol (41.5%), Midazolam (36.4%), Etomidate (17.8%), and Ketamine (14.2%).

The choice of induction agent for intubation may have the potential to minimise or exacerbate complication and mortality. Although considerable research has been carried out, critical central question concern which induction agent is most effective in minimizing cardiovascular instability during intubation. As Kotani and Risotto declared in their recent systematic review, the available findings are insufficient to support conclusive statements. Further studies are needed to identify the optimal agent and dosage, taking into account patient variability and concurrent therapeutic interventions.

Understanding the impact of induction agent selection in critically ill patients has the potential to guide clinical practice in emergency and intensive care settings. Identifying agents with improved survival and prognosis would optimize patient management and inform decision-making for airway management in this vulnerable population. Moreover, delineating which agents exert minimal adverse effects on mortality and prognosis may provide valuable insight for anesthesiologists, intensivists, emergency medicine physicians, and trauma physicians.

• Study Type: Observational
• Enrollment (Estimated): 4

Contacts and Locations

• Study Contact: Name: TOLGA SARAÇOĞLU, Prof,MD; Phone Number: +1 (904) 524-5932; Email: kemaltolgasaracoglu@gmail.com
• Study Contact Backup: Name: Tolga Saraçoğlu, Asc Prof,MD; Phone Number: +1 (904) 524-5932; Email: kemaltolgasaracoglu@gmail.com

Study Locations

• United States
  • Florida
    • Jacksonville, Florida, United States, 32209
      • Recruiting
      • UF Health Jacksonville (Shands Hospital)
      • Contact: TOLGA Saraçoğlu, prof,md; Phone Number: 904-524-5932; Email: kemaltolgasaracoglu@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

ICU admitted, critically ill patients The study population will include critically ill trauma patients aged 18 years and older who were admitted to the surgical intensive care unit

Description

Inclusion Criteria:

• Age ≥ 18 years
• Admission to the surgical ICU for critical care
• Administration of one of the studied induction agents
• Availability of complete clinical data

Exclusion Criteria:

• Age < 18 years
• Absence of documented induction agent administration
• Incomplete or missing medical records

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
propofol; required induction of the following agent in ICU patient	Procedure: induction type for intubation in ICU; Clinical data documented throughout the course of hospitalization will be retrieved and analyzed.
ketamine; required induction of the following agent in ICU patient	Procedure: induction type for intubation in ICU; Clinical data documented throughout the course of hospitalization will be retrieved and analyzed.
ethomidate; required induction of the following agent in ICU patient	Procedure: induction type for intubation in ICU; Clinical data documented throughout the course of hospitalization will be retrieved and analyzed.
midazolam; required induction of the following agent in ICU patient	Procedure: induction type for intubation in ICU; Clinical data documented throughout the course of hospitalization will be retrieved and analyzed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary Outcome will be all-cause mortality at day 7 following tracheal intubation	mortality at day 7	day 7

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peri-intubation cardiovascular collapse	occurrence after induction	perioperatively
Clinical course outcomes	hospital mortality	days

Collaborators and Investigators

• Sponsor: Zeliha Alicikus
• Collaborators: University of Florida
• Investigators: Principal Investigator: TOLGA SARAÇOĞLU, Prof,MD, Florida University Jacksonville

Study record dates

Study Major Dates

• Study Start (Estimated): April 18, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: October 21, 2025
• First Submitted That Met QC Criteria: October 27, 2025
• First Posted (Actual): October 29, 2025

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 11, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: intubation, critically ill patients, airway management
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pathological Conditions, Signs and Symptoms; Critical Illness; Investigative Techniques; Therapeutics; Health Care Facilities Workforce and Services; Health Facilities; Hospital Units; Intubation; Intensive Care Units
• Other Study ID Numbers: Tolga-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No