Ketamine-based sedation use in mechanically ventilated critically ill patients with COVID-19: A multicenter cohort study

Aljuhani, Ohoud, Al Sulaiman, Khalid, Korayem, Ghazwa B., Altebainawi, Ali F., Alshaya, Abdulrahman, Nahari, Majed, Alsamnan, Khuzama, Alkathiri, Munirah A., Al-Dosari, Bodoor S., Alenazi, Abeer A., Alsohimi, Samiah, Alnajjar, Lina I., Alfaifi, Mashael, AlQussair, Nora, Alanazi, Reem M., Alhmoud, Munirah F., Alanazi, Nadin L., Alkofide, Hadeel, Alenezi, Aljawharah M. and Vishwakarma, Ramesh ORCID: (2024) Ketamine-based sedation use in mechanically ventilated critically ill patients with COVID-19: A multicenter cohort study. Saudi Pharmaceutical Journal, 32 (5). ISSN 1319-0164

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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.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Depositing User: LivePure Connector
Date Deposited: 09 Apr 2024 12:30
Last Modified: 06 Jun 2024 15:26
DOI: 10.1016/j.jsps.2024.102061


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