Peters Bradley J, Kooda Kirstin J, Brown Caitlin S, Miles Todd M, Kangas Corrie A, Mara Kristin C, Rivera Mariela, Skrupky Lee P
Department of Pharmacy, Mayo Clinic, Rochester, MN.
Department of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN.
Crit Care Explor. 2024 Jan 25;6(2):e1041. doi: 10.1097/CCE.0000000000001041. eCollection 2024 Feb.
Evaluate effectiveness and safety outcomes associated with the use of ketamine for primary analgosedation in the surgical/trauma ICU setting.
Retrospective cohort study.
Academic medical center in Minnesota.
Patients admitted to the surgical ICU between 2015 and 2019 requiring mechanical ventilation and meeting one of three definitions for ketamine primary analgosedation were included: 1) no concomitant opioid infusion, 2) ketamine monotherapy for greater than or equal to 6 hours with subsequent opioid infusion, or 3) ketamine initiated concomitantly or within 4 hours of opioid and total opioid duration less than 4 hours.
None.
Use of ketamine, analgesics, and sedatives were evaluated. Pain, sedation, and delirium assessments immediately before and during ketamine infusion were collected and compared with reported goals. Concomitant analgesics, sedatives, and psychotropics were recorded. Reported failures due to ineffectiveness and toxicity were collected.
Of 164 included patients, 88% never received a concomitant opioid infusion (primary analgosedation definition 1), 12% met alternative criteria for primary analgosedation (definitions 2 and 3). A majority, 68%, were surgical admissions and mean Acute Physiology and Chronic Health Evaluation III score was 90 (± 30). Median mechanical ventilation duration was 2.5 days (1.1-4.5) and ICU length of stay of 4.9 days (3-8). The median ketamine infusion dose and duration were 0.18 mg/kg/hr (0.1-0.3) and 30 hours (15.1-51.8). Concomitant infusions of propofol and dexmedetomidine were administered in 49% and 29% of patients, respectively. During ketamine infusion, the median percent of total pain scores at goal was 62% (33-96%), while 64% (37-91%) of Richmond Agitation Sedation Scale scores were at goal, and 47% of patients were Confusion Assessment Method-ICU positive during the ketamine infusion. Hallucinations were documented in 14% of patients and ketamine failure occurred in 11% of patients.
Ketamine may be an effective primary analgosedation option in intubated surgical ICU patients, but prospective randomized studies are needed to evaluate this strategy.
评估在外科/创伤重症监护病房（ICU）中使用氯胺酮进行主要镇痛镇静的有效性和安全性结果。
回顾性队列研究。
明尼苏达州的学术医疗中心。
纳入2015年至2019年间入住外科ICU且需要机械通气并符合氯胺酮主要镇痛镇静三种定义之一的患者：1）未同时输注阿片类药物；2）氯胺酮单药治疗大于或等于6小时，随后输注阿片类药物；或3）在阿片类药物开始时或开始后4小时内开始使用氯胺酮，且阿片类药物总使用时间少于4小时。
无。
评估氯胺酮、镇痛药和镇静剂的使用情况。收集氯胺酮输注前及输注期间的疼痛、镇静和谵妄评估结果，并与报告的目标进行比较。记录同时使用的镇痛药、镇静剂和精神药物。收集因无效和毒性导致的报告失败情况。
164例纳入患者中，88%从未同时输注阿片类药物（主要镇痛镇静定义1），12%符合主要镇痛镇静的替代标准（定义2和3）。大多数患者（68%）为外科入院患者，急性生理与慢性健康状况评估III（APACHE III）评分的平均值为90（±30）。机械通气的中位持续时间为2.5天（1.1 - 4.5天），ICU住院时间为4.9天（3 - 8天）。氯胺酮输注剂量和持续时间的中位数分别为0.18mg/kg/小时（0.1 - 0.3mg/kg/小时）和30小时（15.1 - 51.8小时）。分别有49%和29%的患者同时输注丙泊酚和右美托咪定。在氯胺酮输注期间，总疼痛评分达到目标的中位数百分比为62%（33% - 96%），而里士满躁动镇静量表（Richmond Agitation Sedation Scale，RASS）评分达到目标的为64%（37% - 91%），47%的患者在氯胺酮输注期间的重症监护病房意识模糊评估法（Confusion Assessment Method for the ICU，CAM-ICU）为阳性。14%的患者记录有幻觉，11%的患者氯胺酮治疗失败。
氯胺酮可能是气管插管外科ICU患者有效的主要镇痛镇静选择，但需要前瞻性随机研究来评估这一策略。
