Ketamine Sedation for Patients With Acute Behavioral Disturbance During Aeromedical Retrieval: A Retrospective Chart Review.

OBJECTIVE: The aim of this study was to determine the prevalence, safety (as measured by the incidence of adverse events), and effectiveness (as measured by the incidence of intubations) of ketamine sedation in patients with acute behavioral disturbance (ABD) during air medical retrieval. METHODS: This was a retrospective observational study. Eligible patients were identified by searching the electronic databases of 2 air medical retrieval services in Queensland, Australia, for adult patients with ABD transported between January 1, 2015, and June 30, 2016. Data abstraction was performed as per standard chart review criteria. The incidences of intubations and adverse reactions were the main outcomes. RESULTS: One hundred twenty-two patients met the inclusion criteria. Thirty-one (25.4%) patients were intubated, 21 (17.2%) for airway protection/respiratory depression and 10 (8.1%) for persistent ABD. Twenty-one (17.2%) patients received ketamine, 3 of whom (14.3%) were intubated for persistent ABD. Nine (42.9%) patients developed hypertension after ketamine, 2 of whom needed intervention. One patient developed hypoxia after ketamine that resolved without intervention, and 1 patient developed increased secretions. No patients developed nausea, vomiting, emergence phenomena, apnea, or laryngospasm. CONCLUSION: Our study suggests that ketamine is a safe and effective agent for sedating patients with ABD during air medical retrieval.

Ketamine sedation during air medical retrieval of an agitated patient.

Air medical retrieval of acutely agitated patients is challenging in terms of safety for all parties involved. We describe a case in which the largest recorded dose of ketamine sedation in air medical history allowed the successful transport of an acutely agitated patient from a remote community.

Description of an assembled noninvasive capnography setup.

BACKGROUND: Noninvasive capnography is not routinely available on portable transport patient monitors but can be useful in respiratory monitoring of spontaneously breathing patients during transport, especially when sedation is administered. We describe an assembled setup of face mask capnography. The purpose of this study was to assess the feasibility and performance of an assembled face mask capnography setup using common transport equipment for invasive monitoring. METHODS: Using a transport monitor with an invasive capnography channel and a mainstream inline capnometer, we assembled a standard oxygen face mask to function as a noninvasive capnogram and tested its performance on 17 healthy adult volunteers. The study assessed the quality of the resultant capnography waveform and with variables such as simulated apnea and head positioning. RESULTS: We were able to show that the assembled noninvasive capnography setup provided adequate waveform in all test subjects and that it reliably triggered the apnoea monitor alarm when respirations were less than 6 breaths/min. CONCLUSIONS: An assembled noninvasive capnography setup is feasible using common portable monitoring devices. It can display capnographic waveforms and allow visual representation of simulated apnoea.

A 3-year retrospective audit of the use of noninvasive positive pressure ventilation via the Oxylog 3000 transport ventilator during air medical retrievals.

INTRODUCTION: The purpose of this study was to describe the safety profile of noninvasive positive pressure ventilation (NIPPV) using the Oxylog 3000 transport ventilator (Drager Medical, Lübeck, Germany) by air medical retrieval teams from the Queensland Section of the Royal Flying Doctor Service of Australia. METHODS: Over a 3-year period, patients identified in clinical transport records to have NIPPV via the Oxylog 3000 transport ventilator during air medical transfer were systematically reviewed on the clinical indication and adverse effects. RESULTS: A total of 29 patients were identified to have had treatment with NIPPV during air medical retrieval. Three patients suffered serious adverse effects of cardiorespiratory arrest during treatment. The main reported adverse event was intolerance of the facemask. There were no documented episodes of vomiting or hypotension. CONCLUSION: The use of NIPPV via the Oxylog 3000 transport ventilator during air medical retrieval requires careful patient selection. The application and management do not differ from standard hospital-based practice.

Ketamine sedation for patients with acute agitation and psychiatric illness requiring aeromedical retrieval.

OBJECTIVE: Aeromedical retrieval services face the difficult problem of appropriate levels of sedation for transport of acutely agitated patients to definitive care. This paper describes a technique using ketamine, which is titratable and avoids problems associated with airway management. METHOD: A 3-year review of a new technique of ketamine sedation by aeromedical retrieval teams from the Cairns base of the Queensland section of the Royal Flying Doctor Service of Australia. Clinical records were systematically reviewed for ketamine administration and signs of adverse events during transport and in the subsequent 72 h. RESULTS: 18 patients were sedated during retrieval with intravenous ketamine. Effective sedation was achieved in all cases, with no significant adverse events noted during retrieval or 72 h afterwards. CONCLUSION: Ketamine sedation is effective and safe in agitated patients with a psychiatric illness in the aeromedical setting and does not lead to worsening agitation in the subsequent 72-h period.