Edwin Lam1, Ankit Rochani2, Gagan Kaushal2, Brandi N Thoma3, Julian Tanjuakio4, Frances Mae West5, Hitoshi Hirose6. 1. Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: Edwin.lam@jefferson.edu. 2. Department of Pharmaceutical Science, Thomas Jefferson University, Philadelphia, PA, USA. 3. Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA, USA. 4. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA. 5. Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. 6. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Abstract
PURPOSE: First-line management of severe asthma exacerbations include the use of inhaled short-acting β-agonists, anticholinergics, and systemic corticosteroids. Continuous intravenous ketamine given at dissociative doses may be a pharmacologic option in patients who are intubated with life-threatening severe bronchospasm unresponsive to standard therapy. We describe the case of a 44-year-old man admitted to the intensive care unit for status asthmaticus requiring intubation and mechanical ventilation. METHODS: The patient developed severe refractory hypercapnic respiratory failure necessitating additional respiratory support with veno-venous extracorporeal membrane oxygenation (ECMO) therapy. Ketamine treatment was initiated at 0.5 mg/kg/h continuous infusion on the day of admission for pain control and required up-titration to 2 mg/kg/h by intensive care unit day 4 for bronchodilation. Whole blood samples were obtained for pharmacokinetic analysis of ketamine during ECMO. FINDINGS: The plasma concentration at steady state was 1018.7 ng/mL, with an estimated clearance of 1.96 L/kg/h after up-titration. The Vd was 14.18 L/kg, the ke was 0.14 hr-1, and the t½ was 5 hours. IMPLICATIONS: Compared with healthy adults, there was a 6.5-fold increase in the Vd. However, the Vd was similar compared with critically ill patients not receiving ECMO. Further studies should focus on the effect of ECMO on ketamine pharmacokinetic properties.
PURPOSE: First-line management of severe asthma exacerbations include the use of inhaled short-acting β-agonists, anticholinergics, and systemic corticosteroids. Continuous intravenous ketamine given at dissociative doses may be a pharmacologic option in patients who are intubated with life-threatening severe bronchospasm unresponsive to standard therapy. We describe the case of a 44-year-old man admitted to the intensive care unit for status asthmaticus requiring intubation and mechanical ventilation. METHODS: The patient developed severe refractory hypercapnic respiratory failure necessitating additional respiratory support with veno-venous extracorporeal membrane oxygenation (ECMO) therapy. Ketamine treatment was initiated at 0.5 mg/kg/h continuous infusion on the day of admission for pain control and required up-titration to 2 mg/kg/h by intensive care unit day 4 for bronchodilation. Whole blood samples were obtained for pharmacokinetic analysis of ketamine during ECMO. FINDINGS: The plasma concentration at steady state was 1018.7 ng/mL, with an estimated clearance of 1.96 L/kg/h after up-titration. The Vd was 14.18 L/kg, the ke was 0.14 hr-1, and the t½ was 5 hours. IMPLICATIONS: Compared with healthy adults, there was a 6.5-fold increase in the Vd. However, the Vd was similar compared with critically illpatients not receiving ECMO. Further studies should focus on the effect of ECMO on ketamine pharmacokinetic properties.
Authors: Maria Rosa Costanzo; Anne Dipchand; Randall Starling; Allen Anderson; Michael Chan; Shashank Desai; Savitri Fedson; Patrick Fisher; Gonzalo Gonzales-Stawinski; Luigi Martinelli; David McGiffin; Jon Smith; David Taylor; Bruno Meiser; Steven Webber; David Baran; Michael Carboni; Thomas Dengler; David Feldman; Maria Frigerio; Abdallah Kfoury; Daniel Kim; Jon Kobashigawa; Michael Shullo; Josef Stehlik; Jeffrey Teuteberg; Patricia Uber; Andreas Zuckermann; Sharon Hunt; Michael Burch; Geetha Bhat; Charles Canter; Richard Chinnock; Marisa Crespo-Leiro; Reynolds Delgado; Fabienne Dobbels; Kathleen Grady; W Kao; Jaqueline Lamour; Gareth Parry; Jignesh Patel; Daniela Pini; Jeffrey Towbin; Gene Wolfel; Diego Delgado; Howard Eisen; Lee Goldberg; Jeff Hosenpud; Maryl Johnson; Anne Keogh; Clive Lewis; John O'Connell; Joseph Rogers; Heather Ross; Stuart Russell; Johan Vanhaecke Journal: J Heart Lung Transplant Date: 2010-08 Impact factor: 10.247
Authors: Ankit Kanaiyalal Rochani; Margaret Wheatley; Brian Edward Oeffinger; John Robert Eisenbrey; Gagan Kaushal Journal: Res Pharm Sci Date: 2020-08-28