Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm

Youssef-Ahmed, M. Z.; Silver, Peter; Nimkoff, Laura; Sagy, Mayer

doi:10.1007/s001340050197

Cited by 29 publications

(43 citation statements)

References 17 publications

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“…158,159 In critically ill children with asthma, a loading dose of ketamine (2 mg/kg) followed by continuous infusions (20-60 mcg/kg/min) significantly improved the PaO 2 /FiO 2 ratio in all patients, the dynamic compliance and PaCO 2 , and peak inspiratory pressures in mechanically ventilated patients. 160 The mean duration of ketamine infusion in this study was 40 ± 31 hours and no significant side effects were noted. Ketamine infusions have been used in patients with near-fatal asthma, in combination with other bronchodilator therapies.…”

Section: Ketaminementioning

confidence: 64%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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Section: Ketaminementioning

confidence: 64%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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“…In the present study, although statistically unimportant, Group KP had slightly better blood oxygen saturation (SpO 2 ) levels. Several studies on ketamine administration report that ketamine decreases pulmonary pressures, preserves functional residual capacity and tidal volume, and increases oxygenation 20,21 . We did not observe any respiratory complications in either group.…”

Section: Discussionmentioning

confidence: 99%

The Comparison of Propofol and Ketofol Side Effects During Sedation with Spinal Anesthesia

Tezcan¹,

Önek²,

Yavuz³

et al. 2017

Kafkas J Med Sci

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“…Mechanically ventilated children require heavy sedation and sometimes muscle relaxants to avoid tachypnea, ventilator asynchrony and to reduce the risk of sudden cough-induced pulmonary barotrauma. Ketamine is a good choice because it provides sedation and bronchodilation with minimal respiratory depression [35]. Ketamine by continuous infusion is the first choice for sedation, usually combined with intermittent or continuous administration of benzodiazepines.…”

Section: Treatmentmentioning

confidence: 99%

Management of Status Asthmaticus in Children

2010

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Asthma is a common chronic inflammatory disorder of the airways characterized by recurrent wheezing, breathlessness, and coughing. Acute exacerbations of asthma can be life-threatening; annual worldwide estimated mortality is 250,000 and most of these deaths are preventable. While most of the acute exacerbations can be managed successfully in the emergency room, few children have severe exacerbations requiring intensive care. Mainstay of treatment for status asthmaticus are inhaled β2 agonist and anticholinergic agents, oxygen along with corticosteroids. Children who do not respond well to initial treatment require parenteral β2 agonist and magnesium. Rarely, sick children need parenteral aminophylline infusion and mechanical ventilation. Guidelines for diagnosis, treatment, ventilator management and supportive care for status asthmaticus in children are discussed in the protocol.

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Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm

Abstract: Continuous infusion of ketamine to mechanically ventilated patients with refractory bronchospasm significantly improves gas exchange and dynamic compliance of the chest.

Cited by 29 publications

References 17 publications

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

The Comparison of Propofol and Ketofol Side Effects During Sedation with Spinal Anesthesia

Management of Status Asthmaticus in Children

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