Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARS-CoV-2.

Autor:	Wyler D; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Torjman MC; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Leong R; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Baram M; Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Denk W; Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, USA., Long SC; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Gawel RJ; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Viscusi ER; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA., Wainer IW; Rowan University, Cooper Medical School, Camden, USA., Schwenk ES; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA.
Jazyk:	angličtina
Zdroj:	Anaesthesia and intensive care [Anaesth Intensive Care] 2024 Mar; Vol. 52 (2), pp. 105-112. Date of Electronic Publication: 2023 Nov 25.
DOI:	10.1177/0310057X231201184
Abstrakt:	Severely ill patients with COVID-19 are challenging to sedate and often require high-dose sedation and analgesic regimens. Ketamine can be an effective adjunct to facilitate sedation of critically ill patients but its effects on sedation level and inflammation in COVID-19 patients have not been studied. This retrospective, observational cohort study evaluated the effect of ketamine infusions on inflammatory biomarkers and clinical outcomes in mechanically ventilated patients with SARS-CoV-2 infection. A total of 186 patients were identified (47 received ketamine, 139 did not). Patients who received ketamine were significantly younger than those who did not (mean (standard deviation) 59.2 (14.2) years versus 66.3 (14.4) years; P  = 0.004), but there was no statistically significant difference in body mass index ( P  = 0.25) or sex distribution ( P  = 0.91) between groups. Mechanically ventilated patients who received ketamine infusions had a statistically significant reduction in Richmond Agitation-Sedation Scale score (-3.0 versus -2.0, P <  0.001). Regarding inflammatory biomarkers, ketamine was associated with a reduction in ferritin ( P  = 0.02) and lactate ( P  = 0.01), but no such association was observed for C-reactive protein ( P  = 0.27), lactate dehydrogenase ( P  = 0.64) or interleukin-6 ( P  = 0.87). No significant association was observed between ketamine administration and mortality (odds ratio 0.971; 95% confidence interval 0.501 to 1.882; P  = 0.93). Ketamine infusion was associated with improved sedation depth in mechanically ventilated COVID-19 patients and provided a modest anti-inflammatory benefit but did not confer benefit with respect to mortality or intensive care unit length of stay. Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Wyler, Leong, Baram, Denk, Long, Gawel and Schwenk have no conflicts of interest. Torjman and Wainer filed a patent application on the use of ketamine metabolites. Viscusi was a consultant or received funding from Heron, Esteve, Innacoll, and Salix. He is a member of the board of directors of the American Society of Regional Anesthesia and Pain Medicine, which endorsed the acute and chronic ketamine guidelines in 2018.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu