Effects of Ketamine Infusion on Breathing and Encephalography in Spontaneously Breathing ICU Patients.
J Intensive Care Med
; 38(3): 299-306, 2023 Mar.
Article
em En
| MEDLINE
| ID: mdl-35934953
ABSTRACT
BACKGROUND:
Preclinical studies suggest that ketamine stimulates breathing. We investigated whether adding a ketamine infusion at low and high doses to propofol sedation improves inspiratory flow and enhances sedation in spontaneously breathing critically ill patients.METHODS:
In this prospective interventional study, twelve intubated, spontaneously breathing patients received ketamine infusions at 5â mcg/kg/min, followed by 10â mcg/kg/min for 1â h each. Airway flow, pressure, and esophageal pressure were recorded during a spontaneous breathing trial (SBT) at baseline, and during the SBT conducted at the end of each ketamine infusion regimen. SBT consisted of one-minute breathing with zero end-expiratory pressure and no pressure support. Changes in inspiratory flow at the pre-specified time points were assessed as the primary outcome. Ketamine-induced change in beta-gamma electroencephalogram power was the key secondary endpoint. We also analyzed changes in other ventilatory parameters respiratory timing, and resistive and elastic inspiratory work of breathing.RESULTS:
Ketamine infusion of 5 and 10â mcg/kg/min increased inspiratory flow (median, IQR) from 0.36 (0.29-0.46) L/s at baseline to 0.47 (0.32-0.57) L/s and 0.44 (0.33-0.58) L/s, respectively (p = .013). Resistive work of breathing decreased from 0.4 (0.1-0.6) J/l at baseline to 0.2 (0.1-0.3) J/l after ketamine 10â mcg/kg/min (p = .042), while elastic work of breathing remained unchanged. Electroencephalogram beta-gamma power (19-44â Hz) increased compared to baseline (p < .01).CONCLUSIONS:
In intubated, spontaneously breathing patients receiving a constant rate of propofol, ketamine increased inspiratory flow, reduced inspiratory work of breathing, and was associated with an "activated" electroencephalographic pattern. These characteristics might facilitate weaning from mechanical ventilation.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Propofol
/
Ketamina
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article