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Effects of continuous ketamine infusion on hemodynamics and mortality in critically ill children


Autoři: Sojin Park aff001;  Ah Young Choi aff002;  Esther Park aff002;  Hyo Jung Park aff001;  Jaehyun Lee aff001;  Hukyoung Lee aff001;  JeongMee Kim aff001;  Joongbum Cho aff002
Působiště autorů: Department of Pharmaceutical Services, Samsung Medical Center, Seoul, Republic of Korea aff001;  Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224035

Souhrn

We investigated the hemodynamic and mortality effects of continuous ketamine infusion in critically ill pediatric patients. We conducted a retrospective cohort study in a tertiary pediatric intensive care unit (PICU). Patients who used continuous sedative from 2015 to 2017 for 24 hours or more were included. We compared blood pressure, heart and respiratory rates, vasogenic medications, and sedation and pain scores for 12 hours before and after initiation of continuous ketamine. The mortality rates for continuous ketamine and Non-ketamine groups were compared by multivariate logistic regression. A total of 240 patients used continuous sedation, and 82 used continuous ketamine. The median infusion rate of ketamine was 8.1 mcg/kg/min, and the median duration was 6 days. Heart rates (138 vs. 135 beat/minute, P = .033) and respiratory rates (31 vs. 25 respiration/minute, P = .001) decreased, but blood pressure (99.9 vs. 101.1 mm Hg, P = .124) and vasogenic medications did not change after ketamine infusion. Continuous ketamine was not a significant risk factor for mortality (hazard ratio 1.352, confidence interval 0.458–3.996). Continous ketamine could be used in PICU without hemodynamic instability. Further studies in randomized controlled design about the effects of continuous ketamine infusion on hemodynamic changes, sedation, and mortality are required.

Klíčová slova:

Death rates – Hospitals – Blood pressure – Hemodynamics – Intensive care units – Heart rate – Sedatives – Sedation


Zdroje

1. Wunsch H, Kahn JM, Kramer AA, Rubenfeld GD. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med. 2009; 37:3031–9. https://doi.org/10.1097/CCM.0b013e3181b02eff doi: 10.1097/CCM.0b013e3181b02eff 19633543

2. Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, et al. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med. 1998; 26:651–9. doi: 10.1097/00003246-199804000-00011 9559601

3. Zimmerman KO, Smith PB, Benjamin DK, Laughon M, Clark R, Traube C, et al. Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants. J Pediatr. 2017; 180:99–104.e1. doi: 10.1016/j.jpeds.2016.07.001 27522446

4. Grathwohl KW. Does ketamine improve postoperative analgesia? More questions than answers. Pain Med. 2011; 12:1135–6. doi: 10.1111/j.1526-4637.2011.01199.x 21848837

5. Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007; 106:687–95; quiz 891–2. doi: 10.1097/01.anes.0000264747.09017.da 17413906

6. Chanques G, Sebbane M, Barbotte E, Viel E, Eledjam JJ, Jaber S. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology. 2007; 107:858–60. doi: 10.1097/01.anes.0000287211.98642.51 18073576

7. Rock MJ, Reyes de la Rocha S, L'Hommedieu CS, Truemper E. Use of ketamine in asthmatic children to treat respiratory failure refractory to conventional therapy. Crit Care Med. 1986; 14:514–6. doi: 10.1097/00003246-198605000-00019 3698618

8. Achar MN, Achar KN. Efficacy of ketamine infusion in refractory asthma complicated by acute myocardial infarction. Anaesth Intensive Care. 1993; 21:115–7. doi: 10.1177/0310057X9302100130 8447581

9. Golding CL, Miller JL, Gessouroun MR, Johnson PN. Ketamine Continuous Infusions in Critically Ill Infants and Children. Ann Pharmacother. 2016; 50:234–41. doi: 10.1177/1060028015626932 26783355

10. Nehama J, Pass R, Bechtler-Karsch A, Steinberg C, Notterman DA. Continuous ketamine infusion for the treatment of refractory asthma in a mechanically ventilated infant: case report and review of the pediatric literature. Pediatr Emerg Care. 1996; 12:294–7. doi: 10.1097/00006565-199608000-00015 8858657

11. Youssef-Ahmed MZ, Silver P, Nimkoff L, Sagy M. Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm. Intensive Care Med. 1996; 22:972–6. doi: 10.1007/bf02044126 8905436

12. Pruskowski KA, Harbourt K, Pajoumand M, Chui SJ, Reynolds HN. Impact of Ketamine Use on Adjunctive Analgesic and Sedative Medications in Critically Ill Trauma Patients. Pharmacotherapy. 2017; 37:1537–44. doi: 10.1002/phar.2042 29023898

13. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41:263–306. doi: 10.1097/CCM.0b013e3182783b72 23269131

14. Yamazaki Y, Oba K, Matsui Y, Morimoto Y. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth. 2018; 32:167–73. doi: 10.1007/s00540-018-2447-2 29332153

15. Levy PD, Willock RJ, Burla M, Brody A, Mahn J, Marinica A, et al. Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction. J Am Soc Hypertens. 2016; 10:906–16. doi: 10.1016/j.jash.2016.10.005 27856202

16. Chernow B, Lake CR, Cruess D, Coyle J, Hughes P, Balestrieri F, et al. Plasma, urine, and CSF catecholamine concentrations during and after ketamine anesthesia. Crit Care Med. 1982; 10:600–3. doi: 10.1097/00003246-198209000-00009 7105769

17. Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res. 2014; 8:283–90. doi: 10.4103/0259-1162.143110 25886322

18. Komatsu T, Singh PK, Kimura T, Nishiwaki K, Bando K, Shimada Y. Differential effects of ketamine and midazolam on heart rate variability. Can J Anaesth. 1995; 42:1003–9. doi: 10.1007/BF03011073 8590488

19. Morris C, Perris A, Klein J, Mahoney P. Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent? Anaesthesia. 2009; 64:532–9. doi: 10.1111/j.1365-2044.2008.05835.x 19413824

20. Braun P, Wenzel V, Paal P. Anesthesia in prehospital emergencies and in the emergency department. Curr Opin Anaesthesiol. 2010; 23:500–6. doi: 10.1097/ACO.0b013e32833bc135 20543679

21. Saegusa K, Furukawa Y, Ogiwara Y, Chiba S. Pharmacologic analysis of ketamine-induced cardiac actions in isolated, blood-perfused canine atria. J Cardiovasc Pharmacol. 1986; 8:414–9. doi: 10.1097/00005344-198603000-00027 2422483

22. Pagel PS, Kampine JP, Schmeling WT, Warltier DC. Ketamine depresses myocardial contractility as evaluated by the preload recruitable stroke work relationship in chronically instrumented dogs with autonomic nervous system blockade. Anesthesiology. 1992; 76:564–72. doi: 10.1097/00000542-199204000-00013 1550282

23. Jakobsen CJ, Torp P, Vester AE, Folkersen L, Thougaard A, Sloth E. Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease. Acta Anaesthesiol Scand. 2010; 54:1137–44. doi: 10.1111/j.1399-6576.2010.02283.x 20712843

24. Davies AO. Hazards of ketamine in ischemic heart disease. Anesth Analg. 1983; 62:1044–5. 6625211

25. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989; 36:186–97. doi: 10.1007/BF03011442 2650898

26. Tobias JD, Martin LD, Wetzel RC. Ketamine by continuous infusion for sedation in the pediatric intensive care unit. Crit Care Med. 1990; 18:819–21. doi: 10.1097/00003246-199008000-00004 2379394

27. Heiberger AL, Ngorsuraches S, Olgun G, Luze L, Leimbach C, Madison H, et al. Safety and Utility of Continuous Ketamine Infusion for Sedation in Mechanically Ventilated Pediatric Patients. J Pediatr Pharmacol Ther. 2018; 23:447–54. doi: 10.5863/1551-6776-23.6.447 30697129

28. Treu CN, Groth CM, Patel JH. The Use of Continuous Ketamine for Analgesia and Sedation in Critically Ill Patients with Opioid Abuse: A Case Series. J Crit Care Med (Targu Mures). 2017; 3:148–52. doi: 10.1515/jccm-2017-0026 29967888

29. Nichols DG, Shaffner DH. Rogers’ Textbook of Pediatric Intensive Care. others] ACAa, editor. Philadelphia: Wolters Kluwer; 2016.

30. Tweed WA, Minuck M, Mymin D. Circulatory responses to ketamine anesthesia. Anesthesiology. 1972; 37:613–9. doi: 10.1097/00000542-197212000-00008 4652778

31. Laishley RS, Burrows FA, Lerman J, Roy WL. Effect of anesthetic induction regimens on oxygen saturation in cyanotic congenital heart disease. Anesthesiology. 1986; 65:673–7. doi: 10.1097/00000542-198612000-00020 3789442

32. Perbet S, Verdonk F, Godet T, Jabaudon M, Chartier C, Cayot S, et al. Low doses of ketamine reduce delirium but not opiate consumption in mechanically ventilated and sedated ICU patients: A randomised double-blind control trial. Anaesth Crit Care Pain Med. 2018; 37:589–95. doi: 10.1016/j.accpm.2018.09.006 30268528

33. Hirota K, Lambert DG. Ketamine: new uses for an old drug? Br J Anaesth. 2011; 107:123–6. doi: 10.1093/bja/aer221 21757548

34. Campos AR, Santos FA, Rao VS. Ketamine-induced potentiation of morphine analgesia in rat tail-flick test: role of opioid-, alpha2-adrenoceptors and ATP-sensitive potassium channels. Biol Pharm Bull. 2006; 29:86–9. doi: 10.1248/bpb.29.86 16394516

35. Mazar J, Rogachev B, Shaked G, Ziv NY, Czeiger D, Chaimovitz C, et al. Involvement of adenosine in the antiinflammatory action of ketamine. Anesthesiology. 2005; 102:1174–81. doi: 10.1097/00000542-200506000-00017 15915030

36. Hirota K, Ishihara H, Matsuki A. Ketamine and the inhibition of albumin extravasation in chemical peritonitis in rat. Eur J Anaesthesiol. 2002; 19:173–6. doi: 10.1017/s0265021502000315 12071236

37. Hudetz JA, Pagel PS. Neuroprotection by ketamine: a review of the experimental and clinical evidence. J Cardiothorac Vasc Anesth. 2010; 24:131–42. doi: 10.1053/j.jvca.2009.05.008 19640746

38. Miller AC, Jamin CT, Elamin EM. Continuous intravenous infusion of ketamine for maintenance sedation. Minerva Anestesiol. 2011; 77:812–20. 21730929

39. Wang H, Wang C, Wang Y, Tong H, Feng Y, Li M, et al. Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis. Curr Med Res Opin. 2019; 35:435–46. doi: 10.1080/03007995.2018.1509573 30086671


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