■氯胺酮具有镇痛作用,抗炎,抗惊厥药,和神经保护特性。然而,支持其在COVID-19机械通气危重患者中使用的证据不足.该研究的目的是评估氯胺酮在危重病中的有效性和安全性,机械通气(MV)的COVID-19患者。
■成人重症COVID-19患者被纳入一项多中心回顾性前瞻性队列研究。包括2020年3月1日至2021年7月31日在沙特阿拉伯的五个ICU入院的患者。入住ICU后24小时内需要MV的符合条件的患者根据氯胺酮的使用情况分为两个亚组(对照与氯胺酮)。主要结果是住院时间(LOS)。市盈率差异,乳酸正常化,MV持续时间,死亡率被认为是次要结局.基于所选标准使用倾向评分(PS)匹配(1:2比率)。
■总共,1,130名患者符合资格标准。其中,1036例(91.7%)为对照组,而94例患者(8.3%)接受氯胺酮。PS匹配后的患者总数,264名患者,包括88名接受氯胺酮治疗的患者(33.3%)。氯胺酮组的LOS显著降低(β系数(95%CI):-0.26(-0.45,-0.07),P=0.008)。此外,与治疗前(6小时)相比,氯胺酮治疗开始后24小时PaO2/FiO2比率显着提高(124.9(92.1,184.5)与106(73.1,129.3;P=0.002)。此外,氯胺酮组的乳酸正常化平均时间明显较短(β系数(95%CI):-1.55(-2.42,-0.69),P<0.01)。然而,MV持续时间或死亡率无显著差异.
■基于氯胺酮的镇静与较低的住院LOS和更快的乳酸正常化相关,但对COVID-19危重患者没有死亡率益处。因此,建议进行更大的前瞻性研究,以评估氯胺酮作为危重成年患者镇静剂的安全性和有效性.
UNASSIGNED: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The
study\'s goal was to assess ketamine\'s effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19.
UNASSIGNED: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort
study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria.
UNASSIGNED: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group\'s LOS was significantly lower (beta coefficient (95 % CI): -0.26 (-0.45, -0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): -1.55 (-2.42, -0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality.
UNASSIGNED: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients.