The effects of nebulized ketamine and intravenous magnesium sulfate on corticosteroid resistant asthma exacerbation; a randomized clinical trial

Abstract

Background and aims Asthma exacerbation is defined as an acute attack of shortness of breath with more than 25% decrease in morning peak flow compared to the baseline on 2 consecutive days, which requires immediate standard therapy. The majority of asthmatic patients are considered to be steroid-sensitive; however, corticosteroid-resistant asthma is a subset of asthma with poor response to corticosteroids and is responsible for frequent hospital admissions. In this study we aimed to compare the effects of two enhancing strategies, the nebulized ketamine and IV magnesium sulfate, in treatment of severe steroid resistant asthma. Materials and methods This double-blind randomized clinical trial was conducted on patients who presented to a referral clinic in Alborz, Iran. Using random allocation, patients were divided into two groups. The first group was treated with nebulized ketamine and the second group was treated with intravenous magnesium sulfate. Peak expiratory flow rates were assessed before the intervention, 30 and 60 min after the intervention and compared with the aid of SPSS software. Results The Peak expiratory flow rates before the intervention, 30 min and 60 min after the intervention was statistically significantly different in both ketamine and magnesium sulfate groups. Peak expiratory flow rates change between 0 and 60 min were 29.4 and 15.2% in the ketamine and magnesium sulfate group respectively. Although the ketamine group showed much higher increase in mean PEFR compared to the MgSO4 groups, there was no statistically significant difference across both groups. Conclusion Our study concluded that combined with standard therapy, both ketamine and IV magnesium sulfate are effective agents in the improvement of PEFR in patients with acute severe asthma that failed to respond to traditional therapies. However, there were no statistically significant difference between the two groups.

Ketamine Attenuates Airway Inflammation via Inducing Inflammatory Cells Apoptosis and Activating Nrf2 Pathway in a Mixed-Granulocytic Murine Asthma Model

“…44 Ketamine has been investigated as a potential treatment for acute asthma attack and refractory status asthmaticus in part due to its sympathomimetic hemodynamic effects, analgesic and sedative effects, and bronchodilating properties. Ketamine has been shown to reduce the likelihood of intubation in children and adults suffering from acute asthma attacks 26,27,29,45 as well as alleviate lung injury by decreasing pro-inflammatory cytokines. [46][47][48][49] In addition to intravenous, inhalational administration of ketamine was shown to improve the peak expiratory flow rates (PEFR) in patients with acute severe asthma that had not responded well to traditional treatments.…”

“…[46][47][48][49] In addition to intravenous, inhalational administration of ketamine was shown to improve the peak expiratory flow rates (PEFR) in patients with acute severe asthma that had not responded well to traditional treatments. 27 Interestingly, some researchers have reported that children receiving intravenous ketamine for acute asthma exacerbation did not experience significant improvement compared to standard treatment. 28 In spite of the growing interest in the use of ketamine for asthma treatment, conflicting conclusions may be due to the limited sample size, insufficient large-scale prospective studies, and incomplete understanding of the mechanisms involved.…”

“…In addition to these common applications, ketamine has received considerable attention for its use in neurological disorders 22,23 and depression, 24 which indicated some new properties of ketamine, such as the regulation of inflammation, apoptosis, oxidative stress, and the immune system. 25 Applications of ketamine in asthma management have been investigated in some clinical trials, [26][27][28][29] but controversial conclusions have been drawn and the underlying mechanisms need to be examined further.…”

Role of Intravenous Magnesium in the Management of Moderate to Severe Exacerbation of Asthma: A Literature Review

“…Previous recommendations advocated intravenous magnesium sulfate (IVMS) as a safe and effective therapy choice for adult patients with severe acute asthma who did not respond to first-line medications [ 17 , 18 ]. Magnesium sulfate is a physiological blood coagulation mediator that aids in releasing histamine and acetylcholine, resulting in bronchodilation.…”

Outcomes in Severe COVID-19 Patients Following Percutaneous Versus Open Surgical Tracheostomy: An Analysis of Clinical and Prognostic Indicators

“…Infected patients may need respiratory support based on their disease severity, including supplemental oxygen therapy, continuous positive airway pressure (CPAP), and invasive mechanical ventilation and intubation. Hence, some of these patients who need prolonged intubation might benefit from tracheostomy [3]. Tracheostomy in COVID-19 patients can be performed in cases of prolonged intubation for more than 21 days and in patients with a known difficult airway [4].…”