Effects of Ketamine Infusion on Breathing and Encephalography in Spontaneously Breathing ICU Patients
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 5 mcg/kg/min, followed by 10 mcg/kg/min for 1 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 10 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 10 mcg/kg/min (p = .042), while elastic work of breathing remained unchanged. Electroencephalogram beta-gamma power (19-44 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
Journal of intensive care medicine - 38(2023), 3 vom: 01. März, Seite 299-306 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Suleiman, Aiman [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 28.12.2022 Date Revised 03.01.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/08850666221119716 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM344543986 |
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| 100 | 1 | |a Suleiman, Aiman |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effects of Ketamine Infusion on Breathing and Encephalography in Spontaneously Breathing ICU Patients |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 28.12.2022 | ||
| 500 | |a Date Revised 03.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a METHODS: In this prospective interventional study, twelve intubated, spontaneously breathing patients received ketamine infusions at 5 mcg/kg/min, followed by 10 mcg/kg/min for 1 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 | ||
| 520 | |a RESULTS: Ketamine infusion of 5 and 10 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 10 mcg/kg/min (p = .042), while elastic work of breathing remained unchanged. Electroencephalogram beta-gamma power (19-44 Hz) increased compared to baseline (p < .01) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ICU sedation | |
| 650 | 4 | |a Ketamine infusion | |
| 650 | 4 | |a brain activity | |
| 650 | 4 | |a critical care ventilation | |
| 650 | 4 | |a inspiratory flow | |
| 650 | 4 | |a mechanical ventilation | |
| 650 | 4 | |a spontaneous breathing trial | |
| 650 | 4 | |a weaning from ventilator | |
| 650 | 7 | |a Ketamine |2 NLM | |
| 650 | 7 | |a 690G0D6V8H |2 NLM | |
| 650 | 7 | |a Propofol |2 NLM | |
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| 700 | 1 | |a Santer, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Munoz-Acuna, Ronny |e verfasserin |4 aut | |
| 700 | 1 | |a Hammer, Maximilian |e verfasserin |4 aut | |
| 700 | 1 | |a Schaefer, Maximilian S |e verfasserin |4 aut | |
| 700 | 1 | |a Wachtendorf, Luca J |e verfasserin |4 aut | |
| 700 | 1 | |a Rumyantsev, Sandra |e verfasserin |4 aut | |
| 700 | 1 | |a Berra, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Chamadia, Shubham |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson-Akeju, Oluwaseun |e verfasserin |4 aut | |
| 700 | 1 | |a Baedorf-Kassis, Elias N |e verfasserin |4 aut | |
| 700 | 1 | |a Eikermann, Matthias |e verfasserin |4 aut | |
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