Evaluating Ketamine Dosing Practices During Emergency Department Intubation Using Shock Index Stratification

Area of Science:

• Emergency Medicine
• Pharmacology
• Critical Care

Background:

• Accurate ketamine dosing during rapid sequence intubation (RSI) is vital in emergency settings, especially with hemodynamic instability.
• Ketamine is used as a sole sedative agent for RSI in adults.
• Shock index (SI) is a key indicator of hemodynamic status.

Purpose of the Study:

• To analyze ketamine dosing practices during RSI in a tertiary emergency department.
• To assess concordance with predefined weight-based and shock index-based dosing ranges.
• To identify variations in ketamine administration based on hemodynamic status.

Main Methods:

• Analysis of intubation data from the Emergency Medicine - Airway Registry (EM-AWARE) (2015-2021).
• Inclusion of adult patients (≥18 years) receiving ketamine as the sole sedative for RSI.
• Stratification into normal (SI < 0.9) and abnormal (SI ≥ 0.9) shock index groups.

Main Results:

• 72% of patients with normal SI received ketamine within the predefined range; 28% received doses below.
• 76% of patients with abnormal SI received reduced doses within the predefined range; 24% received doses outside, mostly above the recommended shock dose.
• Overall, 24-28% of patients received ketamine doses outside predefined ranges, irrespective of shock index.

Conclusions:

• Approximately one-quarter of emergency department patients received ketamine doses outside recommended ranges during intubation.
• Ketamine dosing variability persists during emergency airway management, regardless of patient shock index.
• Further standardization of ketamine dosing protocols in emergency settings may be warranted.