Minnesota Poison Control System, Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, United States.
Department of Emergency Medicine, Hennepin County Medical Center, United States.
Am J Emerg Med. 2018 May;36(5):789-796. doi: 10.1016/j.ajem.2017.10.022. Epub 2017 Oct 7.
We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation.
This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality.
Forty-nine patients were enrolled. Median age was 29years (range 18-66); 76% (37/49) were male. Median time to adequate sedation was 4.2min (95% CI: 2.5-5.9, range 1-25min) and 90% (44/49) had adequate sedation prehospital. Seven patients (14%) received a second sedative prehospital. Intubation occurred in 57% (28/49) of patients. Mechanical ventilation lasted <24h in 82% (23/28) of patients, and <48h in 96% (27/28) of patients. A single physician intubated 36% (10/28) of the patients. Complications related to ketamine included hypersalivation (n=9, 18%), vomiting (n=3, 6%), and emergence reaction (n=2, 4%). One patient died from complications of septic shock on hospital day 29, likely unrelated to ketamine.
In patients with prehospital profound agitation, ketamine provides rapid effective sedation when used as a primary therapy. Intubation was common but accompanied by a short duration of mechanical ventilation and appears to have been subject to individual physician practice variation.
研究氯胺酮作为院前深度激越的一线治疗药物的效果。
这是一项前瞻性观察性研究，对因深度激越（Altered Mental Status Scale [AMSS] 评分为+4，即从-4（无反应）到+4（最激越）的激越验证序数量表上的+4）而接受 5mg/kg 肌肉注射氯胺酮的患者进行研究。主要结局是达到充分镇静的时间（AMSS<+1）。次要结局包括需要额外镇静剂、插管频率、与氯胺酮相关的并发症以及死亡率。
共纳入 49 例患者。中位年龄为 29 岁（范围 18-66 岁）；76%（37/49）为男性。达到充分镇静的中位时间为 4.2 分钟（95%CI：2.5-5.9，范围 1-25 分钟），90%（44/49）在院前达到充分镇静。7 例（14%）患者在院前接受了第二种镇静剂。57%（28/49）的患者插管。82%（23/28）的患者机械通气持续时间<24 小时，96%（27/28）的患者机械通气持续时间<48 小时。有一位医生单独为 36%（10/28）的患者进行了插管。与氯胺酮相关的并发症包括流涎过多（n=9，18%）、呕吐（n=3，6%）和觉醒反应（n=2，4%）。一名患者因败血症性休克并发症于入院第 29 天死亡，可能与氯胺酮无关。
在院前深度激越的患者中，氯胺酮作为一线治疗药物可迅速有效地镇静。插管很常见，但机械通气时间短，且似乎存在个体医生实践差异。
