Ketamine analgo-sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine.

Autor: Amer M; Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.; College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia., Møller MH; Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Guidelines in Intensive Care Medicine, Development and Evaluation (GUIDE) Group, The Research Institute of St. Joe's, Hamilton, Canada., Alshahrani M; Department of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Shehabi Y; School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.; Clinical School of Medicine, University of New South Wales, Randwick Campus, New South Wales, Australia., Arabi YM; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alshamsi F; Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates., Sigurðsson MI; Faculty of Medicine, University of Iceland, Reykjavík, Iceland.; Division of Anaesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland., Rehn M; Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway.; The Norwegian Air Ambulance Foundation, Oslo, Norway.; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway., Chew MS; Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden., Kalliomäki ML; Department of Anaesthesia, Tampere University Hospital, Tampere, Finland., Lewis K; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada., Al-Suwaidan FA; Division of Neurology, Department of Medicine, Security Forces Hospital, Riyadh, Saudi Arabia.; Neurology Clinical Lead, Ministry of Health, Riyadh, Saudi Arabia.; College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.; College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia., Al-Dorzi HM; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al-Fares A; Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Minister of Health, Kuwait City, Kuwait.; Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Advance Respiratory and Cardiac Failure, Ministry of Health, Kuwait City, Kuwait., Alsadoon N; Alshaya International Trading Company, Riyadh, Saudi Arabia., Bell CM; Medical University of South Carolina Hospital Authority, Charleston, South Carolina, USA.; Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA., Groth CM; University of Rochester Medical Center, Rochester, New York, USA., Parke R; School of Nursing University of Auckland, Auckland, New Zealand.; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand., Mehta S; Department of Medicine, Mount Sinai Hospital; Interdepartmental Division of Intensive Care Medicine, Toronto, Canada., Wischmeyer PE; Deptartments of Anesthesiology and Surgery, Duke University School of Medicine, Durham, North Carolina, USA., Al-Omari A; Critical Care Department, Dr Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia., Olkkola KT; Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Alhazzani W; Guidelines in Intensive Care Medicine, Development and Evaluation (GUIDE) Group, The Research Institute of St. Joe's, Hamilton, Canada.; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.; Scientific Research Center, Directorate General of Armed Forces Medical Services, Riyadh, Saudi Arabia.
Jazyk: angličtina
Zdroj: Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2024 Oct; Vol. 68 (9), pp. 1161-1178. Date of Electronic Publication: 2024 Aug 28.
DOI: 10.1111/aas.14470
Abstrakt: Background: This Rapid Practice Guideline (RPG) aimed to provide evidence-based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research.
Methods: The RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up-to-date systematic review and meta-analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence-to-decision framework were used to assess the certainty of evidence and to move from evidence to decision/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients' values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities.
Results: Data from 17 randomized clinical trials (n = 898) and nine observational studies (n = 1934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo-sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28 days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] -0.05 days; 95% CI -0.07 to -0.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg/kg/h morphine equivalent) (MD -11.6; 95% CI -20.4 to -2.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient-important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied.
Conclusion: The RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo-sedation in critically ill adults on iMV when other analgo-sedatives are available; and (2) using ketamine as an adjunct to non-ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non-ketamine usual care sedatives alone. Large-scale trials should provide additional evidence.
(© 2024 Acta Anaesthesiologica Scandinavica Foundation.)
Databáze: MEDLINE
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