Megan A Van Berkel1, Matthew C Exline2, Kari M Cape3, Lindsay P Ryder4, Gary Phillips5, Naeem A Ali6, Bruce A Doepker7. 1. Department of Pharmacy, Methodist LeBohneur Healthcare- University Hospital, 1265 Union Ave., Memphis, TN 38104. Electronic address: Megan.VanBerkel@mlh.org. 2. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, 201 Davis Heart & Lung Research Institute, 473 West 12th Ave, Columbus, OH 43210. Electronic address: Matthew.exline@osumc.edu. 3. Department of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, 410 W. 10th Ave, Columbus, OH 43204. Electronic address: Kari.cape@osumc.edu. 4. Department of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, 410 W. 10th Ave, Columbus, OH 43204. Electronic address: Lindsay.ryder@osumc.edu. 5. The Ohio State University Center for Biostatistics, 2012 Kenny Road, Columbus, OH 43221. Electronic address: Gary.Phillips@osumc.edu. 6. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 West 12th Ave, Columbus, OH 43210. Electronic address: Naeem.ali@osumc.edu. 7. Department of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, 410 W. 10th Ave, Columbus, OH 43204. Electronic address: Bruce.doepker@osumc.edu.
Abstract
PURPOSE: This study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation. MATERIALS AND METHODS: This single-center, retrospective propensity-matched cohort study included septic patients admitted to our medical intensive care unit who received either etomidate or ketamine for intubation. Clinical hypotension was defined as any one of the following: mean arterial pressure (MAP) decrease >40% compared to baseline and MAP <70 mmHg, MAP <60 mmHg, initiation of a vasopressor, or increase to >30% of the initial vasopressor dose. RESULTS: Patients were matched based on propensity scores determined by demographics and baseline characteristics. A total of 384 (200 etomidate and 184 ketamine) patients were included for analysis with 230 patients (115 in each group) matched. Clinical hypotension was less prevalent in patients who received ketamine as compared to etomidate [51.3% vs. 73% (odds ratio=0.39, 95% confidence interval=0.22-0.67, P=.001]. The etomidate group experienced significantly lower MAPs at time periods 6.1-12 hours (65.1 mmHg vs. 69.3 mmHg, P=.01) and 12.1-24 hours (63.9 mmHg vs. 68.4 mmHg, P=.003). CONCLUSIONS: Ketamine was associated with a lower incidence of clinical hypotension within the 24 hour period following endotracheal intubation in septic patients.
PURPOSE: This study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation. MATERIALS AND METHODS: This single-center, retrospective propensity-matched cohort study included septicpatients admitted to our medical intensive care unit who received either etomidate or ketamine for intubation. Clinical hypotension was defined as any one of the following: mean arterial pressure (MAP) decrease >40% compared to baseline and MAP <70 mmHg, MAP <60 mmHg, initiation of a vasopressor, or increase to >30% of the initial vasopressor dose. RESULTS:Patients were matched based on propensity scores determined by demographics and baseline characteristics. A total of 384 (200 etomidate and 184 ketamine) patients were included for analysis with 230 patients (115 in each group) matched. Clinical hypotension was less prevalent in patients who received ketamine as compared to etomidate [51.3% vs. 73% (odds ratio=0.39, 95% confidence interval=0.22-0.67, P=.001]. The etomidate group experienced significantly lower MAPs at time periods 6.1-12 hours (65.1 mmHg vs. 69.3 mmHg, P=.01) and 12.1-24 hours (63.9 mmHg vs. 68.4 mmHg, P=.003). CONCLUSIONS:Ketamine was associated with a lower incidence of clinical hypotension within the 24 hour period following endotracheal intubation in septicpatients.
Authors: Nicholas M Mohr; Stephen G Pape; Dan Runde; Amy H Kaji; Ron M Walls; Calvin A Brown Journal: Acad Emerg Med Date: 2020-07-20 Impact factor: 3.451