Successful Use of Ketamine for Central Neurogenic Hyperventilation: A Case Report

This report describes the use of ketamine in a patient with central neurogenic hyperventilation following intracerebral hemorrhage. A 41-year-old man was admitted with right thalamic intracerebral hemorrhage with intraventricular extension requiring emergent external ventricular drain placement. After aggressive management of his neurologic status and other associated complications, the patient subacutely developed an altered respiratory pattern characterized by shallow, rapid breaths. After the use of multiple sedative agents to control respiratory drive had failed, a single 2 mg/kg bolus dose of intravenous ketamine was administered. In the 6 hours prior to ketamine dosing, respiratory rate ranged from 24 to 40 breaths per minute. Within minutes of ketamine administration, respiratory patterns improved and primarily ranged from 16 to 20. Twenty-four hours after ketamine administration, the patient was successfully extubated following 12 days of mechanical ventilation. Further research is needed to determine the widespread applicability of this strategy.