High-Frequency Analysis of the Cerebral Physiological Impact of Ketamine in Acute Traumatic Neural Injury.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2025-02-20 eCollection Date: 2025-01-01 DOI:10.1089/neur.2024.0146
Davis McClarty, Logan Froese, Tobias Bergmann, Kevin Y Stein, Amanjyot S Sainbhi, Abrar Islam, Nuray Vakitbilir, Noah Silvaggio, Izabella Marquez, Alwyn Gomez, Frederick A Zeiler
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Abstract

Acute traumatic neural injury, also known as traumatic brain injury (TBI), is a leading cause of death. TBI treatment focuses on the use of sedatives, vasopressors, and invasive intracranial pressure (ICP) monitoring to mitigate ICP elevations and maintain cerebral perfusion pressure (CPP). While common sedatives such as propofol and fentanyl have significant side effects, ketamine is an attractive alternative due to its rapid onset and cardiovascular stability. Despite these benefits, ketamine's use remains controversial due to historical concerns about increasing ICP. Using high-frequency monitoring, this retrospective study compared cerebral pressure-flow dynamics in patients with moderate/severe TBI who received ketamine with those who did not. Statistical analysis included descriptive statistics, comparisons within and between patients receiving ketamine, and evaluation of physiological response around incremental dose changes in ketamine. Various cerebral physiological indices were analyzed, including ICP, CPP, regional cerebral oxygen delivery, intracranial compliance, and cardiovascular reactivity metrics. A total of 122 patients were studied, with 17 receiving ketamine (median age: 37 years) and 105 not receiving ketamine (median age: 42 years). Results indicated higher median ICP in the ketamine group compared with the no ketamine group (9.05 mmHg and 14.00 mmHg, respectively, p = 0.00017); however, this is likely due to differences in patient characteristics and injury severity between the groups. No significant differences were observed in any other index of cerebral pressure-flow dynamics or between any incremental dose change condition. These findings suggest that ketamine does not significantly impact cerebral pressure-flow dynamics, challenging historical concerns about its use in patients with TBI.

氯胺酮对急性外伤性神经损伤脑生理影响的高频分析。
急性创伤性神经损伤,也称为创伤性脑损伤(TBI),是导致死亡的主要原因。TBI治疗的重点是使用镇静剂、血管加压剂和侵入性颅内压(ICP)监测,以减轻ICP升高和维持脑灌注压(CPP)。虽然常见的镇静剂如异丙酚和芬太尼有明显的副作用,但氯胺酮是一种有吸引力的替代品,因为它起效快,心血管稳定。尽管有这些好处,氯胺酮的使用仍然存在争议,因为历史上担心会增加ICP。利用高频监测,这项回顾性研究比较了接受氯胺酮治疗和未接受氯胺酮治疗的中重度TBI患者的脑压力-血流动力学。统计分析包括描述性统计、接受氯胺酮治疗的患者内部和患者之间的比较,以及氯胺酮剂量增加变化前后的生理反应评估。分析各种脑生理指标,包括ICP、CPP、局部脑氧输送、颅内顺应性和心血管反应性指标。研究共纳入122例患者,其中17例接受氯胺酮治疗(中位年龄37岁),105例未接受氯胺酮治疗(中位年龄42岁)。结果显示,氯胺酮组中位ICP高于未使用氯胺酮组(分别为9.05 mmHg和14.00 mmHg, p = 0.00017);然而,这可能是由于两组患者特征和损伤严重程度的差异。其他脑压-血流动力学指标及不同剂量变化条件间均无显著差异。这些发现表明氯胺酮对脑压力-血流动力学没有显著影响,挑战了历史上对其在TBI患者中使用的担忧。
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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来源期刊
CiteScore
2.40
自引率
0.00%
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