Khatib Sohaib, Roelofsz David, Singh Som, Rao Arjun, Brinton Taylor, Howell Gregory
Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Ochsner J. 2022 Fall;22(3):225-229. doi: 10.31486/toj.22.0032.
Sedation and analgesia in the intensive care unit (ICU) are major clinical challenges, and several continuous infusion medications have been used for these purposes. The use of these sedative medications has been associated with hemodynamic effects that complicate the patient's critical illness. Continuous ketamine infusion is an emerging sedative option that has been used more frequently in the ICU since 2017. The purpose of this study was to characterize the hemodynamic differences between 3 continuous sedative infusions: ketamine, propofol, and midazolam. For this single-center retrospective cohort study, we collected data for patients hospitalized between January 2015 and April 2020 at Saint Luke's Health System in Kansas City, Missouri. Adult patients in the ICU requiring a norepinephrine infusion and sedation were included. The change in norepinephrine requirement from baseline at 1 hour was the primary outcome. The change in vasopressor requirement at 3 and 30 hours after initiation of the infusion was also tabulated. Sixty-eight critically ill patients with several types of shock requiring vasopressor support with norepinephrine were enrolled in our study. Patients who received ketamine had an increase in norepinephrine requirement compared to midazolam and propofol, although this difference was not statistically significant. In our study, continuous ketamine infusion did not reveal a statistically significant favorable hemodynamic effect compared with propofol and midazolam because of the small sample size. A trend toward an unfavorable hemodynamic effect is not expected, but large randomized trials are needed to further evaluate the hemodynamic effects of continuous ketamine infusion in the ICU.
重症监护病房（ICU）中的镇静和镇痛是主要的临床挑战，已有多种持续输注药物用于这些目的。这些镇静药物的使用与血流动力学效应相关，这使患者的危重病况更加复杂。持续输注氯胺酮是一种新兴的镇静选择，自2017年以来在ICU中使用得越来越频繁。本研究的目的是描述三种持续镇静输注药物（氯胺酮、丙泊酚和咪达唑仑）之间的血流动力学差异。在这项单中心回顾性队列研究中，我们收集了2015年1月至2020年4月在密苏里州堪萨斯城圣卢克医疗系统住院患者的数据。纳入了ICU中需要去甲肾上腺素输注和镇静的成年患者。主要结局是1小时时去甲肾上腺素需求量相对于基线的变化。还列出了输注开始后3小时和30小时时血管升压药需求量的变化。我们的研究纳入了68例患有几种类型休克且需要去甲肾上腺素进行血管升压支持的危重病患者。与咪达唑仑和丙泊酚相比，接受氯胺酮治疗的患者去甲肾上腺素需求量增加，尽管这种差异无统计学意义。在我们的研究中，由于样本量小，与丙泊酚和咪达唑仑相比，持续输注氯胺酮未显示出统计学上显著的有利血流动力学效应。虽然预计不会出现血流动力学效应不利的趋势，但仍需要大型随机试验来进一步评估ICU中持续输注氯胺酮的血流动力学效应。
