Essamedin M Negm, Hossam Tharwat Ali, Hanaa A Nofal, Ahmed Mosallem, Ashraf Elsayed Ahmed, Ahmed Ali Morsy, Tamer S Elserafy, Marwan Elgohary, Khaled Mohamed Altaher, Sherif Sharaf El Deen, Hani A Albialy, Ahmed M Gouda, Ahmed Beniamen
{"title":"小剂量氯胺酮输注对感染性休克患者颅内压和血流动力学的影响。","authors":"Essamedin M Negm, Hossam Tharwat Ali, Hanaa A Nofal, Ahmed Mosallem, Ashraf Elsayed Ahmed, Ahmed Ali Morsy, Tamer S Elserafy, Marwan Elgohary, Khaled Mohamed Altaher, Sherif Sharaf El Deen, Hani A Albialy, Ahmed M Gouda, Ahmed Beniamen","doi":"10.1007/s12028-025-02302-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Septic shock is a recognized cause of global mortality in intensive care units. Sedation and analgesia management are essential for patients with sepsis or hemodynamic instability. Although considered safe concerning hemodynamic changes, ketamine use might cause a substantial rise in intracranial pressure (ICP).</p><p><strong>Methods: </strong>An interventional study was conducted at the intensive care unit of Zagazig University Hospitals from December 2021 to March 2023 and covered 100 adult patients with septic shock requiring mechanical ventilation, sedation, and vasopressors. Patients with acute brain injury were excluded. Noninvasive ICP including ICP derived from pulsatility index, ICP derived from diastolic flow velocity (ICP<sub>FVd</sub>), and ICP derived from optic nerve sheath diameter, and hemodynamic monitoring were measured before adjunct low-dosage (0.3 μg/kg/hr) continuous ketamine infusion (T0), after 12 h (T1), and after 24 h of infusion (T2).</p><p><strong>Results: </strong>Baseline ICP derived from optic nerve sheath diameter, ICP derived from pulsatility index, and ICP<sub>FVd</sub> medians were 14.5 (interquartile range [IQR] 7), 16.8 (IQR 0.91), and 13.8 (IQR 9.38) mm Hg, respectively. Only ICP<sub>FVd</sub> showed a significant slight increase from 13.75 (IQR 8.5) at T1 to 13.90 (IQR 8.5) at T2 (P value = 0.042). The baseline median noninvasive cerebral perfusion pressure was 74.56 (IQR 12.39) mm Hg without significant change at T1 or T2 (P value = 0.09). The respiratory rate, heart rate, and mean arterial blood pressure showed no significant changes across timepoints (P values = 0.95, 0.86, and 0.14, respectively). The median doses of midazolam, fentanyl, and norepinephrine significantly decreased across the study timepoints, especially at the first 12 h (P value < 0.001 for each).</p><p><strong>Conclusions: </strong>The present pilot study showed promising results of low-dose continuous ketamine infusion adjunctly on ICP and hemodynamics with a substantial reduction of sedatives and vasopressor dose. Further studies with large sample sizes and longer duration of administration and follow-up are needed to expand the current findings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients.\",\"authors\":\"Essamedin M Negm, Hossam Tharwat Ali, Hanaa A Nofal, Ahmed Mosallem, Ashraf Elsayed Ahmed, Ahmed Ali Morsy, Tamer S Elserafy, Marwan Elgohary, Khaled Mohamed Altaher, Sherif Sharaf El Deen, Hani A Albialy, Ahmed M Gouda, Ahmed Beniamen\",\"doi\":\"10.1007/s12028-025-02302-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Septic shock is a recognized cause of global mortality in intensive care units. Sedation and analgesia management are essential for patients with sepsis or hemodynamic instability. Although considered safe concerning hemodynamic changes, ketamine use might cause a substantial rise in intracranial pressure (ICP).</p><p><strong>Methods: </strong>An interventional study was conducted at the intensive care unit of Zagazig University Hospitals from December 2021 to March 2023 and covered 100 adult patients with septic shock requiring mechanical ventilation, sedation, and vasopressors. Patients with acute brain injury were excluded. Noninvasive ICP including ICP derived from pulsatility index, ICP derived from diastolic flow velocity (ICP<sub>FVd</sub>), and ICP derived from optic nerve sheath diameter, and hemodynamic monitoring were measured before adjunct low-dosage (0.3 μg/kg/hr) continuous ketamine infusion (T0), after 12 h (T1), and after 24 h of infusion (T2).</p><p><strong>Results: </strong>Baseline ICP derived from optic nerve sheath diameter, ICP derived from pulsatility index, and ICP<sub>FVd</sub> medians were 14.5 (interquartile range [IQR] 7), 16.8 (IQR 0.91), and 13.8 (IQR 9.38) mm Hg, respectively. Only ICP<sub>FVd</sub> showed a significant slight increase from 13.75 (IQR 8.5) at T1 to 13.90 (IQR 8.5) at T2 (P value = 0.042). The baseline median noninvasive cerebral perfusion pressure was 74.56 (IQR 12.39) mm Hg without significant change at T1 or T2 (P value = 0.09). The respiratory rate, heart rate, and mean arterial blood pressure showed no significant changes across timepoints (P values = 0.95, 0.86, and 0.14, respectively). The median doses of midazolam, fentanyl, and norepinephrine significantly decreased across the study timepoints, especially at the first 12 h (P value < 0.001 for each).</p><p><strong>Conclusions: </strong>The present pilot study showed promising results of low-dose continuous ketamine infusion adjunctly on ICP and hemodynamics with a substantial reduction of sedatives and vasopressor dose. 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引用次数: 0
摘要
背景：感染性休克是全球重症监护病房死亡的公认原因。镇静和镇痛管理是必要的患者败血症或血流动力学不稳定。虽然氯胺酮被认为对血流动力学的改变是安全的，但它的使用可能会导致颅内压（ICP）的大幅升高。方法：于2021年12月至2023年3月在扎加齐格大学附属医院重症监护室进行介入研究，纳入100例需要机械通气、镇静和血管加压药物治疗的感染性休克成年患者。排除急性脑损伤患者。在辅助低剂量（0.3 μg/kg/hr）连续氯胺酮输注前（T0）、输注后12 h （T1）、输注后24 h （T2）测量无创ICP，包括脉搏指数ICP、舒张血流速度ICP （ICPFVd）、视神经鞘直径ICP，并进行血流动力学监测。结果：视神经鞘直径、脉搏指数和ICPFVd的基线ICP中位数分别为14.5（四分位间距[IQR] 7）、16.8 （IQR 0.91）和13.8 (IQR 9.38) mm Hg。只有ICPFVd从T1时的13.75 （IQR 8.5）增加到T2时的13.90 (IQR 8.5) （P值= 0.042）。基线无创脑灌注压中位数为74.56 (IQR 12.39) mm Hg， T1或T2无显著变化（P值= 0.09）。呼吸频率、心率和平均动脉血压在不同时间点无显著变化（P值分别为0.95、0.86和0.14）。咪达唑仑、芬太尼和去甲肾上腺素的中位剂量在研究时间点上显著降低，尤其是在前12小时（P值）。结论：本初步研究显示，低剂量连续氯胺酮输注辅助颅内压和血流动力学具有良好的效果，同时镇静剂和血管加压剂的剂量也显著减少。需要更大样本量、更长的给药和随访时间的进一步研究来扩大目前的发现。
Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients.
Background: Septic shock is a recognized cause of global mortality in intensive care units. Sedation and analgesia management are essential for patients with sepsis or hemodynamic instability. Although considered safe concerning hemodynamic changes, ketamine use might cause a substantial rise in intracranial pressure (ICP).
Methods: An interventional study was conducted at the intensive care unit of Zagazig University Hospitals from December 2021 to March 2023 and covered 100 adult patients with septic shock requiring mechanical ventilation, sedation, and vasopressors. Patients with acute brain injury were excluded. Noninvasive ICP including ICP derived from pulsatility index, ICP derived from diastolic flow velocity (ICPFVd), and ICP derived from optic nerve sheath diameter, and hemodynamic monitoring were measured before adjunct low-dosage (0.3 μg/kg/hr) continuous ketamine infusion (T0), after 12 h (T1), and after 24 h of infusion (T2).
Results: Baseline ICP derived from optic nerve sheath diameter, ICP derived from pulsatility index, and ICPFVd medians were 14.5 (interquartile range [IQR] 7), 16.8 (IQR 0.91), and 13.8 (IQR 9.38) mm Hg, respectively. Only ICPFVd showed a significant slight increase from 13.75 (IQR 8.5) at T1 to 13.90 (IQR 8.5) at T2 (P value = 0.042). The baseline median noninvasive cerebral perfusion pressure was 74.56 (IQR 12.39) mm Hg without significant change at T1 or T2 (P value = 0.09). The respiratory rate, heart rate, and mean arterial blood pressure showed no significant changes across timepoints (P values = 0.95, 0.86, and 0.14, respectively). The median doses of midazolam, fentanyl, and norepinephrine significantly decreased across the study timepoints, especially at the first 12 h (P value < 0.001 for each).
Conclusions: The present pilot study showed promising results of low-dose continuous ketamine infusion adjunctly on ICP and hemodynamics with a substantial reduction of sedatives and vasopressor dose. Further studies with large sample sizes and longer duration of administration and follow-up are needed to expand the current findings.
期刊介绍：
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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