Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm
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Published on: January 17, 2011
M Z Youssef-Ahmed1, P Silver, L Nimkoff
1Division of Critical Care Medicine, Schneider Children's Hospital, New Hyde Park, NY 11042, USA.
Insights
Ketamine infusion significantly improved oxygenation and lung compliance in mechanically ventilated children with severe bronchospasm. This treatment facilitated successful weaning from mechanical ventilation for all patients.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Refractory bronchospasm in mechanically ventilated children poses significant challenges.
- Conventional treatments often prove insufficient for severe cases.
- Investigating novel therapeutic agents is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the efficacy of ketamine infusion in mechanically ventilated pediatric patients with refractory bronchospasm.
- To assess the impact of ketamine on gas exchange and respiratory mechanics.
Main Methods:
- Retrospective chart review of 17 pediatric patients in a PICU.
- Patients received ketamine infusion (2 mg/kg bolus, then 20-60 mcg/kg/min) for refractory bronchospasm.
- PaO2/FIO2 ratio and dynamic compliance were primary outcome measures.
Main Results:
- Ketamine infusion led to a significant increase in the PaO2/FIO2 ratio (p < 0.0001).
- Dynamic compliance significantly improved in mechanically ventilated patients (p < 0.0001).
- All patients were successfully weaned from mechanical ventilation and discharged.
Conclusions:
- Continuous ketamine infusion is a beneficial treatment for mechanically ventilated children with refractory bronchospasm.
- Ketamine improves gas exchange and lung mechanics in this critical patient population.
- Further research may explore optimal ketamine dosing and long-term effects.
Objective:
To determine whether ketamine infusion to mechanically ventilated children with refractory bronchospasm is beneficial.
Design:
Retrospective chart review.
Setting:
Pediatric intensive care unit (PICU) of a children's hospital.
Patients:
Seventeen patients, ages ranging from 5 months to 17 years (mean 6 +/- 5.7 years), were admitted to our PICU over a 3-year period and received ketamine infusion during a course of mechanical ventilation. The patients had acute respiratory failure associated with severe bronchospasm due to status asthmaticus (n = 11), bronchiolitis caused by respiratory syncytial virus (n = 4), and bacterial pneumonia (n = 2).
Interventions:
All patients had been mechanically ventilated for 1-5 days (2.2 +/- 1.5 days) and received conventional treatment to relieve bronchospasm for more than 24 h prior to the initiation of ketamine treatment. An intravenous bolus of ketamine of 2 mg/kg, followed by continuous infusions of 20-60 micrograms/kg per minute (32 +/- 10 micrograms/kg per minute) was administered to all patients without changing their preexisting bronchodilatory regimen. Benzodiazepines were also given intravenously to all patients during the ketamine treatment.
Measurements And Main Results:
The PaO2/FIO2 ratio in all patients (n = 17) and the dynamic compliance in the volume-preset mechanically ventilated patients (n = 12) were calculated. The PaO2/FIO2 ratio increased significantly from 116 +/- 55 before ketamine, to 174 +/- 82, 269 +/- 151, and 248 +/- 124 at 1, 8, and 24 h respectively, after the initiation of the ketamine infusion (p < 0.0001). Dynamic compliance increased from 5.78 +/- 2.8 cm3/cmH2O to 7.05 +/- 3.39, 7.29 +/- 3.37, and 8.58 +/- 3.69, respectively (p < 0.0001). PaCO2 and peak inspiratory pressure followed a similar trend of improvement with ketamine administration. The mean duration of the ketamine infusion was 40 +/- 31 h. One patient required glycopyrrolate 0.4 mg/day to control excessive airway secretions and one patient required an additional dose of diazepam to control hallucinations while emerging from ketamine. All patients were successfully weaned from mechanical ventilation and discharged from the PICU.
Conclusion:
Continuous infusion of ketamine to mechanically ventilated patients with refractory bronchospasm significantly improves gas exchange and dynamic compliance of the chest.
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