Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study
Backgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectivenes...
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| Format: | Article |
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Elsevier
2024-05-01
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| Series: | Saudi Pharmaceutical Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1319016424001117 |
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| author | Ohoud Aljuhani Khalid Al Sulaiman Ghazwa B. Korayem Ali F. Altebainawi Abdulrahman Alshaya Majed Nahari Khuzama Alsamnan Munirah A. Alkathiri Bodoor S. Al-Dosari Abeer A. Alenazi Samiah Alsohimi Lina I. Alnajjar Mashael Alfaifi Nora AlQussair Reem M. Alanazi Munirah F. Alhmoud Nadin L. Alanazi Hadeel Alkofide Aljawharah M. Alenezi Ramesh Vishwakarma |
| author_facet | Ohoud Aljuhani Khalid Al Sulaiman Ghazwa B. Korayem Ali F. Altebainawi Abdulrahman Alshaya Majed Nahari Khuzama Alsamnan Munirah A. Alkathiri Bodoor S. Al-Dosari Abeer A. Alenazi Samiah Alsohimi Lina I. Alnajjar Mashael Alfaifi Nora AlQussair Reem M. Alanazi Munirah F. Alhmoud Nadin L. Alanazi Hadeel Alkofide Aljawharah M. Alenezi Ramesh Vishwakarma |
| author_sort | Ohoud Aljuhani |
| collection | DOAJ |
| description | Backgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19. Methods: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria. Results: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group's LOS was significantly lower (beta coefficient (95 % CI): −0.26 (−0.45, −0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): −1.55 (−2.42, −0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality. Conclusions: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients. |
| first_indexed | 2024-04-24T12:52:09Z |
| format | Article |
| id | doaj.art-701440ec1787450eae42d9babc522920 |
| institution | Directory Open Access Journal |
| issn | 1319-0164 |
| language | English |
| last_indexed | 2024-04-24T12:52:09Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Saudi Pharmaceutical Journal |
| spelling | doaj.art-701440ec1787450eae42d9babc5229202024-04-06T04:39:35ZengElsevierSaudi Pharmaceutical Journal1319-01642024-05-01325102061Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort StudyOhoud Aljuhani0Khalid Al Sulaiman1Ghazwa B. Korayem2Ali F. Altebainawi3Abdulrahman Alshaya4Majed Nahari5Khuzama Alsamnan6Munirah A. Alkathiri7Bodoor S. Al-Dosari8Abeer A. Alenazi9Samiah Alsohimi10Lina I. Alnajjar11Mashael Alfaifi12Nora AlQussair13Reem M. Alanazi14Munirah F. Alhmoud15Nadin L. Alanazi16Hadeel Alkofide17Aljawharah M. Alenezi18Ramesh Vishwakarma19Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi ArabiaPharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia; Saudi Society for Multidisciplinary Research Development and Education (SCAPE Society), Riyadh, Saudi Arbia; Corresponding author at: King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426 Riyadh, Saudi Arabia.Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi ArabiaPharmaceutical Care Services, King Salman Specialist Hospital, Hail Health Cluster, Hail, Saudi Arabia; Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi ArabiaPharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs, Riyadh, Saudi ArabiaPharmaceutical Care Services, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi ArabiaDepartment of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi ArabiaPharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi ArabiaPharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaPharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaPharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaDepartment of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi ArabiaPharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi ArabiaPharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaPharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi ArabiaDepartment of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaNorwich Medical School, University of East Anglia, Norwich, United KingdomBackgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19. Methods: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria. Results: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group's LOS was significantly lower (beta coefficient (95 % CI): −0.26 (−0.45, −0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): −1.55 (−2.42, −0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality. Conclusions: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients.http://www.sciencedirect.com/science/article/pii/S1319016424001117COVID-19KetamineOxygenation parameterPaO2/FiO2 ratioLength of StayCritically ill |
| spellingShingle | Ohoud Aljuhani Khalid Al Sulaiman Ghazwa B. Korayem Ali F. Altebainawi Abdulrahman Alshaya Majed Nahari Khuzama Alsamnan Munirah A. Alkathiri Bodoor S. Al-Dosari Abeer A. Alenazi Samiah Alsohimi Lina I. Alnajjar Mashael Alfaifi Nora AlQussair Reem M. Alanazi Munirah F. Alhmoud Nadin L. Alanazi Hadeel Alkofide Aljawharah M. Alenezi Ramesh Vishwakarma Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study Saudi Pharmaceutical Journal COVID-19 Ketamine Oxygenation parameter PaO2/FiO2 ratio Length of Stay Critically ill |
| title | Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study |
| title_full | Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study |
| title_fullStr | Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study |
| title_full_unstemmed | Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study |
| title_short | Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study |
| title_sort | ketamine based sedation use in mechanically ventilated critically ill patients with covid 19 a multicenter cohort study |
| topic | COVID-19 Ketamine Oxygenation parameter PaO2/FiO2 ratio Length of Stay Critically ill |
| url | http://www.sciencedirect.com/science/article/pii/S1319016424001117 |
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