Department of Pharmacy, Baylor University Medical Center, Dallas, Texas.
Baylor Scott and White Research Institute, Dallas, Texas.
J Opioid Manag. 2022 May-Jun;18(3):257-264. doi: 10.5055/jom.2022.0717.
Ketamine has been shown to decrease opioid utilization as an adjunct, but limited evidence is available on ketamine as a primary analgesic strategy.
A retrospective chart review.
Mechanically ventilated adult patients (≥18 years) in the surgery-trauma intensive care unit (STICU) with continuous infusion ketamine or fentanyl with concomitant propofol for at least 12 hours were screened for inclusion. The final analysis included 22 patients in the ketamine/propofol (KP) group and 24 patients in the fentanyl/propofol (FP) group.
Patients in the STICU received KP or FP continuous infusions.
The primary outcome compared opioid requirements between both groups during mechanical ventilation.
The median opioid requirement during mechanical ventilation was significantly higher in the FP group compared to the KP group (median 1,392 milligrams of morphine equivalents (MMEs) [interquartile range (IQR) 709.5-2,292] versus 206.3 MME [IQR 87-510], p < 0.001). After extubation, there was no difference in opioid utilization. Patients in the KP group spent less time at goal Critical Care Pain Observation Tool compared to the FP group (median 77.6 percent, IQR [71.9-85.2] versus 88.9 percent, IQR [76.9-97.4], p = 0.003). The proportions of patients developing adverse effects were not significantly different between the two groups.
Among critically ill mechanically ventilated patients in the STICU, continuous ketamine resulted in signifi-cantly less opioids during mechanical ventilation. Further studies with a larger sample size are needed to assess the ap-propriate dosing strategy for ketamine to produce adequate analgesia when used as a primary analgesic in mechanically ventilated patients.
已有研究表明，氯胺酮作为辅助药物可以减少阿片类药物的使用，但关于氯胺酮作为主要镇痛策略的证据有限。
回顾性病历分析。
筛选出至少接受 12 小时持续输注氯胺酮或芬太尼联合丙泊酚的机械通气成年患者（≥18 岁）纳入研究。最终分析纳入了氯胺酮/丙泊酚（KP）组 22 例患者和芬太尼/丙泊酚（FP）组 24 例患者。
患者入住外科创伤加强护理病房（STICU）后接受 KP 或 FP 持续输注。
主要观察指标比较两组患者在机械通气期间的阿片类药物需求。
FP 组患者在机械通气期间的阿片类药物需求中位数明显高于 KP 组（中位数 1392 毫克吗啡等效物（MME）[四分位距（IQR）709.5-2292]比 206.3 MME [IQR 87-510]，p<0.001）。拔管后，两组患者的阿片类药物使用无差异。与 FP 组相比，KP 组患者达到关键护理疼痛观察工具目标的时间更短（中位数 77.6%，IQR [71.9-85.2]比 88.9%，IQR [76.9-97.4]，p=0.003）。两组患者不良反应发生率无显著差异。
在 STICU 接受机械通气的重症患者中，持续输注氯胺酮可显著减少机械通气期间的阿片类药物使用。需要进一步进行更大样本量的研究，以评估在机械通气患者中作为主要镇痛药物使用时氯胺酮的适当剂量策略，以达到足够的镇痛效果。
