Ketamine in status asthmaticus: A review

Area of Science:

• Pulmonology
• Anesthesiology
• Critical Care Medicine

Background:

• Status asthmaticus is a severe respiratory condition associated with significant morbidity and mortality.
• Ketamine has emerged as a potential adjunct therapy for severe asthma, showing promise in improving patient outcomes.
• Its role in alleviating the need for mechanical ventilation in refractory cases is of particular interest.

Purpose of the Study:

• To review the pulmonary effects of ketamine in the context of severe asthma.
• To evaluate the existing evidence supporting the use of ketamine for refractory status asthmaticus.
• To determine if current data justifies its routine clinical application.

Main Methods:

• A comprehensive literature search was conducted across major databases (MEDLINE, EMBASE, Google Scholar, Cochrane) up to January 2012.
• Keywords included "ketamine", "asthma", "bronchospasm", "bronchodilator", and "mechanical ventilation".
• Relevant articles and ongoing trials were reviewed, analyzing outcomes such as indication, dosage, respiratory mechanics, adverse effects, and mortality.

Main Results:

• Twenty reports involving 244 patients demonstrated ketamine's efficacy in acute severe asthma unresponsive to standard treatments.
• Patients receiving ketamine showed clinical improvement, reduced oxygen needs, and avoided invasive ventilation.
• Mechanically ventilated patients experienced improved respiratory mechanics, gas exchange, and successful weaning.

Conclusions:

• Ketamine exhibits potential as a bronchodilator in severe asthma cases.
• Current evidence suggests benefits in improving respiratory parameters and reducing the need for mechanical ventilation.
• A large-scale prospective clinical trial is necessary to establish definitive treatment guidelines for ketamine in status asthmaticus.