Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study).

IF 1.8 Q3 CRITICAL CARE MEDICINE

Critical Care Research and Practice Pub Date : 2024-07-27 eCollection Date: 2024-01-01 DOI:10.1155/2024/6626899

Christine M Groth, Christopher A Droege, Preeyaporn Sarangarm, Michaelia D Cucci, Kyle A Gustafson, Kathryn A Connor, Kimberly Kaukeinen, Nicole M Acquisto, Sai Ho J Chui, Deepali Dixit, Alexander H Flannery, Nina E Glass, Helen Horng, Mojdeh S Heavner, Justin Kinney, William J Peppard, Andrea Sikora, Brian L Erstad

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Abstract

Objective: Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs).

Methods: Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI. Adverse effects were collected over the first 7 days of CI ketamine.

Results: Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (n = 13), 92% intubated (n = 22), 25% on CI vasopressors (n = 6), and 33% on CI paralytics (n = 8). Ketamine indications were analgesia/sedation (n = 21, 87.5%) and status epilepticus (n = 3, 12.5%). Median starting dose was 0.5 (0.48-0.70) mg/kg/hr and continued for a median of 2.4 (1.3-4.4) days. There was a significant difference in mean proportion of time spent within goal pain score range (24H prior: 74% ± 14%, 0-24H: 85% ± 10%, and 25-48H: 72% ± 20%; p=0.014). A significant reduction in median morphine milligram equivalents (MME) was seen (24H prior: 58 (8-195) mg vs. 0-24H: 4 (0-69) mg and p=0.01), but this was not sustained (25-48H: 24 (2-246) mg and p=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%).

Conclusions: Ketamine CI improved time in goal pain score range and significantly reduced MME, but this was not sustained. Larger prospective studies are needed in the pediatric population.

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儿科重症监护室使用氯胺酮的多中心回顾性研究（氯胺酮-重症监护室研究）。

目的描述在儿科重症监护病房（PICU）中持续输注氯胺酮（CI）的做法，并评估其对疼痛/镇静评分、镇痛药/镇静剂暴露和不良反应（AEs）的影响：多中心、回顾性、儿童观察研究结果：纳入了来自 4 个 PICU 的 24 名患者；中位数（IQR）年龄为 7（1-13.25）岁，54% 为女性（n = 13），92% 插管（n = 22），25% 使用 CI 血管加压剂（n = 6），33% 使用 CI 麻痹剂（n = 8）。氯胺酮的适应症为镇痛/镇静（21 人，87.5%）和癫痫状态（3 人，12.5%）。起始剂量中位数为 0.5 (0.48-0.70) mg/kg/hr，持续中位数为 2.4 (1.3-4.4) 天。在目标疼痛评分范围内度过的平均时间比例存在显著差异（24 小时前：74% ± 14%；0-24 小时：85% ± 10%；25-48 小时：72% ± 20%；P=0.014）。吗啡毫克当量（MME）中位数明显减少（24 小时前：58（8-195）毫克，0-24 小时：4（0-69）毫克，p=0.01），但这种减少并不持久（25-48 小时：24（2-246）毫克，p=0.29）。常见的AE为心动过速（63%）、低血压（54%）、分泌物/抽吸（29%）和出现反应（13%）：氯胺酮 CI 可缩短疼痛评分在目标范围内的时间，并显著降低 MME，但这种效果并不持久。需要在儿科人群中开展更大规模的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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