Monday, July 15, 2024

Impact of Early Ketamine Use in Mechanically Ventilated COVID-19 Patients

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Within the pandemic’s peak, hospitals worldwide faced the daunting task of managing critically ill COVID-19 patients. A study delving into the early use of ketamine in such patients has unveiled significant insights into its effects on clinical outcomes and hospital mortality. Conducted across 610 hospitals and involving thousands of patients, this retrospective cohort study offers a comprehensive analysis of ketamine’s role in managing severe COVID-19 cases.

Study Design and Patient Cohort

The study analyzed data from 610 hospitals contributing to the Premier Healthcare Database between April 2020 and June 2021. The patient cohort consisted of adults with COVID-19 who required at least two consecutive days of mechanical ventilation within five days of hospitalization. Early ketamine use was defined as initiation within two days of intubation and continuation for more than one day.

Primary and Secondary Outcomes

Primary outcomes measured included hospital mortality, while secondary outcomes encompassed ICU length of stay (LOS), ventilator days, vasopressor days, renal replacement therapy (RRT), and total hospital costs. Propensity score matching was employed to adjust for confounding factors, ensuring a balanced comparison between patients who received ketamine and those who did not.

Out of 42,954 patients, 1,423 (3.3%) were exposed to early ketamine. Post-matching, the analysis included 1,390 patients in each group. Findings revealed that ketamine recipients experienced higher hospital mortality (52.5% vs. 45.9%), longer median ICU stays (13 vs. 12 days), and extended ventilator dependency (12 vs. 11 days). However, hospital LOS, vasopressor days, and RRT showed no significant differences between the groups.

Key Insights and Implications

– Ketamine use was linked to higher hospital mortality.
– Patients on ketamine had longer ICU stays and ventilator days.
– No significant impact on hospital LOS, vasopressor days, or RRT was observed.
– The total hospital cost was higher for ketamine recipients.

In conclusion, early ketamine administration in mechanically ventilated COVID-19 patients was associated with increased mortality and higher overall costs. This study underscores the need for randomized trials to better understand ketamine’s role in critical care settings, especially considering its potential impact on patient outcomes and healthcare resources.

Original Article: Crit Care Explor. 2024 Jun 21;6(7):e1105. doi: 10.1097/CCE.0000000000001105. eCollection 2024 Jul 1.

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