Baumgartner Laura, Townsend Nicole, Winkelman Katie, MacLaren Robert
Laura Baumgartner is an assistant professor in the College of Pharmacy at Touro University California, Vallejo. Nicole Townsend is a physician in the Department of Surgery, University of Colorado Hospital, Aurora. Katie Winkelman is a clinical nurse educator in the Burn Center at the University of Colorado Hospital. Robert MacLaren is a professor in the Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora. The authors gratefully acknowledge the contributions of Michael Schurr, MD, to the study design. Contact author: Laura Baumgartner,
Am J Nurs. 2018 Jul;118(7):26-31. doi: 10.1097/01.NAJ.0000541433.66712.61.
: Objective: Traditional analgesic regimens often fail to control the severe pain patients experience during burn wound care, and the drugs are frequently administered at doses that can cause oversedation and respiratory depression. Ketamine may be an ideal agent for adjunctive analgesia in such patients because of its unique mechanism of action and lack of association with respiratory depression. This study evaluated the efficacy and safety of a critical care RN-driven protocol for IV ketamine administration during burn wound care.
This retrospective cohort study examined all adult burn patients who received ketamine as part of a critical care RN-driven ketamine protocol for burn wound care from September 2011 through September 2013. Efficacy outcomes were opioid and benzodiazepine requirements (expressed as fentanyl and midazolam equivalents, respectively) four hours after ketamine administration compared with four hours before such administration. Safety parameters assessed were neurologic, hemodynamic, and respiratory effects.
Twenty-seven patients received 56 ketamine doses as part of this protocol; the mean (SD) dose was 0.75 (0.35) mg/kg. Twenty patients (74%) were male and seven (26%) were female; mean age was 39 years. The average percentage of total body surface area burned was 23.4%. With the protocol, opioid and benzodiazepine requirements were reduced by 29% and 20%, respectively. One patient experienced an episode of oversedation after concomitant administration of ketamine and fentanyl. No patients experienced neurologic or hemodynamic complications following ketamine administration.
The administration of ketamine during burn wound care using a critical care RN-driven protocol was associated with reduced opioid and benzodiazepine requirements and few adverse effects. Prospective studies are needed to investigate additional patient outcomes and the independent administration of ketamine by critical care RNs.
目的：传统镇痛方案常常无法控制烧伤患者伤口护理期间所经历的剧痛，而且药物给药剂量常常会导致过度镇静和呼吸抑制。氯胺酮可能是此类患者辅助镇痛的理想药物，因为其独特的作用机制且与呼吸抑制无关。本研究评估了在烧伤伤口护理期间由重症护理注册护士推动的静脉注射氯胺酮方案的疗效和安全性。
这项回顾性队列研究检查了2011年9月至2013年9月期间所有接受氯胺酮治疗的成年烧伤患者，氯胺酮治疗是重症护理注册护士推动的烧伤伤口护理氯胺酮方案的一部分。疗效指标是氯胺酮给药后4小时与给药前4小时相比的阿片类药物和苯二氮䓬类药物需求量（分别以芬太尼和咪达唑仑当量表示）。评估的安全参数包括神经、血流动力学和呼吸影响。
27名患者作为该方案的一部分接受了56剂氯胺酮治疗；平均（标准差）剂量为0.75（0.35）mg/kg。20名患者（74%）为男性，7名（26%）为女性；平均年龄为39岁。全身烧伤总面积的平均百分比为23.4%。采用该方案后，阿片类药物和苯二氮䓬类药物的需求量分别降低了29%和20%。1名患者在同时使用氯胺酮和芬太尼后出现过度镇静发作。氯胺酮给药后没有患者出现神经或血流动力学并发症。
在烧伤伤口护理期间采用由重症护理注册护士推动的方案给予氯胺酮，与阿片类药物和苯二氮䓬类药物需求量减少以及不良反应较少相关。需要进行前瞻性研究以调查其他患者结局以及重症护理注册护士独立给予氯胺酮的情况。
