氯胺酮输注对机械通气SARS-CoV-2患者镇静深度、炎症及临床转归影响的观察研究

IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI:10.1177/0310057X231201184
David Wyler, Marc C Torjman, Ron Leong, Michael Baram, William Denk, Sara C Long, Richard J Gawel, Eugene R Viscusi, Irving W Wainer, Eric S Schwenk
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引用次数: 0

摘要

COVID-19重症患者很难镇静,通常需要大剂量镇静和镇痛方案。氯胺酮可有效辅助重症患者镇静,但其对COVID-19患者镇静水平和炎症的影响尚未研究。这项回顾性、观察性队列研究评估了氯胺酮输注对机械通气的SARS-CoV-2感染患者炎症生物标志物和临床结局的影响。共确定186例患者(47例接受氯胺酮治疗,139例未接受氯胺酮治疗)。接受氯胺酮治疗的患者明显比未接受氯胺酮治疗的患者年轻(平均(标准差)59.2(14.2)岁对66.3(14.4)岁;P = 0.004),但两组间体重指数(P = 0.25)和性别分布(P = 0.91)差异无统计学意义。接受氯胺酮输注的机械通气患者的Richmond激动-镇静量表评分降低具有统计学意义(-3.0 vs -2.0, P 0.001)。在炎症生物标志物方面,氯胺酮与铁蛋白(P = 0.02)和乳酸(P = 0.01)的减少有关,但与c反应蛋白(P = 0.27)、乳酸脱氢酶(P = 0.64)或白细胞介素-6 (P = 0.87)的减少没有关联。氯胺酮给药与死亡率无显著相关性(比值比0.971;95%置信区间0.501 ~ 1.882;p = 0.93)。氯胺酮输注与机械通气的COVID-19患者镇静深度的改善有关,并提供适度的抗炎益处,但在死亡率或重症监护病房住院时间方面没有益处。
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Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARS-CoV-2.

Severely ill patients with COVID-19 are challenging to sedate and often require high-dose sedation and analgesic regimens. Ketamine can be an effective adjunct to facilitate sedation of critically ill patients but its effects on sedation level and inflammation in COVID-19 patients have not been studied. This retrospective, observational cohort study evaluated the effect of ketamine infusions on inflammatory biomarkers and clinical outcomes in mechanically ventilated patients with SARS-CoV-2 infection. A total of 186 patients were identified (47 received ketamine, 139 did not). Patients who received ketamine were significantly younger than those who did not (mean (standard deviation) 59.2 (14.2) years versus 66.3 (14.4) years; P = 0.004), but there was no statistically significant difference in body mass index (P = 0.25) or sex distribution (P = 0.91) between groups. Mechanically ventilated patients who received ketamine infusions had a statistically significant reduction in Richmond Agitation-Sedation Scale score (-3.0 versus -2.0, P < 0.001). Regarding inflammatory biomarkers, ketamine was associated with a reduction in ferritin (P = 0.02) and lactate (P = 0.01), but no such association was observed for C-reactive protein (P = 0.27), lactate dehydrogenase (P = 0.64) or interleukin-6 (P = 0.87). No significant association was observed between ketamine administration and mortality (odds ratio 0.971; 95% confidence interval 0.501 to 1.882; P = 0.93). Ketamine infusion was associated with improved sedation depth in mechanically ventilated COVID-19 patients and provided a modest anti-inflammatory benefit but did not confer benefit with respect to mortality or intensive care unit length of stay.

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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
150
审稿时长
3 months
期刊介绍: Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine.
期刊最新文献
JG Farrell and The Lung: An early description of intensive care delirium in literature. Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review. MET call prevention. A cross-sectional study of the relationship between iron deficiency anaemia and chronic pain. Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia.
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