Division of Critical Care Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Division of Pediatric Neurological Surgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Crit Care Med. 2023 May 1;51(5):563-572. doi: 10.1097/CCM.0000000000005806. Epub 2023 Feb 21.
The acute cerebral physiologic effects of ketamine in children have been incompletely described. We assessed the acute effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children with severe traumatic brain injury (TBI).
In this retrospective observational study, patients received bolus doses of ketamine for sedation or as a treatment for ICP crisis (ICP > 20 mm Hg for > 5 min). Administration times were synchronized with ICP and CPP recordings at 1-minute intervals logged in an automated database within the electronic health record. ICP and CPP were each averaged in epochs following drug administration and compared with baseline values. Age-based CPP thresholds were subtracted from CPP recordings and compared with baseline values. Trends in ICP and CPP over time were assessed using generalized least squares regression.
A 30-bed tertiary care children's hospital PICU.
Children with severe TBI who underwent ICP monitoring.
None.
We analyzed data from 33 patients, ages 1 month to 16 years, 22 of whom received bolus doses of ketamine, with 127 doses analyzed. Demographics, patient, and injury characteristics were similar between patients who did versus did not receive ketamine boluses. In analysis of the subset of ketamine doses used only for sedation, there was no significant difference in ICP or CPP from baseline. Eighteen ketamine doses were given during ICP crises in 11 patients. ICP decreased following these doses and threshold-subtracted CPP rose.
In this retrospective, exploratory study, ICP did not increase following ketamine administration. In the setting of a guidelines-based protocol, ketamine was associated with a reduction in ICP during ICP crises. If these findings are reproduced in a larger study, ketamine may warrant consideration as a treatment for intracranial hypertension in children with severe TBI.
氯胺酮对儿童急性脑生理的影响尚未完全描述。我们评估了氯胺酮对严重创伤性脑损伤（TBI）患儿颅内压（ICP）和脑灌注压（CPP）的急性影响。
在这项回顾性观察性研究中，患者接受氯胺酮推注用于镇静或治疗 ICP 危机（ICP>20mmHg 持续>5min）。药物给药时间与 ICP 和 CPP 记录同步，在电子病历中的自动数据库中以 1 分钟的间隔记录。给药后，ICP 和 CPP 分别在每个时段取平均值，并与基线值进行比较。将基于年龄的 CPP 阈值从 CPP 记录中减去，并与基线值进行比较。使用广义最小二乘回归评估 ICP 和 CPP 随时间的趋势。
一家 30 张床位的三级儿童重症监护病房 PICU。
接受 ICP 监测的严重 TBI 患儿。
无。
我们分析了 33 名年龄在 1 个月至 16 岁的患儿的数据，其中 22 名患者接受了氯胺酮推注，共分析了 127 个剂量。未接受和接受氯胺酮推注的患者之间的人口统计学、患者和损伤特征相似。在仅用于镇静的氯胺酮剂量亚组分析中，与基线相比，ICP 或 CPP 无显著差异。11 名患者中有 18 次在 ICP 危机期间给予氯胺酮剂量。这些剂量后 ICP 下降，阈值减去 CPP 上升。
在这项回顾性探索性研究中，氯胺酮给药后 ICP 没有增加。在基于指南的方案中，氯胺酮与 ICP 危机期间 ICP 的降低相关。如果这些发现在更大的研究中得到重现，氯胺酮可能值得考虑作为治疗严重 TBI 儿童颅内高压的一种方法。
