Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm.
OBJECTIVE
To determine whether ketamine infusion to mechanically ventilated children with refractory bronchospasm is beneficial.


METHODS
Retrospective chart review.


METHODS
Pediatric intensive care unit (PICU) of a children's hospital.


METHODS
Seventeen patients, ages ranging from 5 months to 17 years (mean 6 +/- 5.7 years), were admitted to our PICU over a 3-year period and received ketamine infusion during a course of mechanical ventilation. The patients had acute respiratory failure associated with severe bronchospasm due to status asthmaticus (n = 11), bronchiolitis caused by respiratory syncytial virus (n = 4), and bacterial pneumonia (n = 2).


METHODS
All patients had been mechanically ventilated for 1-5 days (2.2 +/- 1.5 days) and received conventional treatment to relieve bronchospasm for more than 24 h prior to the initiation of ketamine treatment. An intravenous bolus of ketamine of 2 mg/kg, followed by continuous infusions of 20-60 micrograms/kg per minute (32 +/- 10 micrograms/kg per minute) was administered to all patients without changing their preexisting bronchodilatory regimen. Benzodiazepines were also given intravenously to all patients during the ketamine treatment.


RESULTS
The PaO2/FIO2 ratio in all patients (n = 17) and the dynamic compliance in the volume-preset mechanically ventilated patients (n = 12) were calculated. The PaO2/FIO2 ratio increased significantly from 116 +/- 55 before ketamine, to 174 +/- 82, 269 +/- 151, and 248 +/- 124 at 1, 8, and 24 h respectively, after the initiation of the ketamine infusion (p < 0.0001). Dynamic compliance increased from 5.78 +/- 2.8 cm3/cmH2O to 7.05 +/- 3.39, 7.29 +/- 3.37, and 8.58 +/- 3.69, respectively (p < 0.0001). PaCO2 and peak inspiratory pressure followed a similar trend of improvement with ketamine administration. The mean duration of the ketamine infusion was 40 +/- 31 h. One patient required glycopyrrolate 0.4 mg/day to control excessive airway secretions and one patient required an additional dose of diazepam to control hallucinations while emerging from ketamine. All patients were successfully weaned from mechanical ventilation and discharged from the PICU.


CONCLUSIONS
Continuous infusion of ketamine to mechanically ventilated patients with refractory bronchospasm significantly improves gas exchange and dynamic compliance of the chest.
Youssef-Ahmed
M Z
MZ
Division of Critical Care Medicine, Schneider Children's Hospital, New Hyde Park, NY 11042, USA.
Silver
P
P
Nimkoff
L
L
Sagy
M
M
D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D001986:Bronchial Spasm / Q000188:drug therapy* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007649:Ketamine / Q000627:therapeutic use*; D008170:Lung Compliance / Q000187:drug effects; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000778:Anesthetics, Dissociative; D007649:Ketamine