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Published on: March 26, 2019
Acute Effects of Ketamine on Intracranial Pressure in Children With Severe Traumatic Brain Injury
Jennifer C Laws1, E Haley Vance2, Kristina A Betters1
1Division of Critical Care Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Insights
Ketamine did not increase intracranial pressure (ICP) in children with severe traumatic brain injury (TBI). In ICP crises, ketamine was associated with reduced ICP and increased cerebral perfusion pressure (CPP).
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Pharmacology
Background:
- The acute effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in pediatric severe traumatic brain injury (TBI) are not well-defined.
- Understanding these effects is crucial for managing TBI patients.
Purpose of the Study:
- To assess the acute effects of ketamine on ICP and CPP in children with severe TBI.
- To determine if ketamine administration impacts ICP and CPP in this vulnerable population.
Main Methods:
- Retrospective observational study in a pediatric intensive care unit (PICU).
- Analyzed data from 33 children with severe TBI undergoing ICP monitoring.
- Ketamine doses for sedation or ICP crisis were synchronized with ICP/CPP recordings.
- Compared ICP and CPP values before and after ketamine administration.
Main Results:
- Ketamine administration did not significantly alter ICP or CPP when used solely for sedation.
- In 11 patients experiencing ICP crises, 18 ketamine doses were administered.
- Following ketamine during ICP crises, ICP decreased and threshold-subtracted CPP increased.
Conclusions:
- Ketamine administration was not associated with an increase in ICP in children with severe TBI.
- Ketamine may be associated with reduced ICP during ICP crises in children with TBI.
- Further research is warranted to confirm these findings and explore ketamine's role in managing intracranial hypertension.
Objectives:
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).
Design:
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.
Setting:
A 30-bed tertiary care children's hospital PICU.
Patients:
Children with severe TBI who underwent ICP monitoring.
Interventions:
None.
Measurements And Main Results:
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.
Conclusions:
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.
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