目的:描述COVID-19机械通气患者早期使用氯胺酮的情况,并研究与院内死亡率和其他临床结局的关系。
方法:回顾性队列研究。
方法:六百多家医院在2020年4月至2021年6月期间向PremierHealthcare数据库提供数据。
方法:患有COVID-19且在住院后5天内连续机械通气大于或等于2天的成年人。
方法:暴露是在插管2天内开始早期使用氯胺酮,并持续超过1天。
方法:主要为住院死亡率。次要结果包括住院时间(LOS)和ICU,呼吸机日,血管加压药天,肾脏替代疗法(RRT),医院总费用。倾向评分匹配分析用于校正混杂因素。
结果:在42,954名患者中,1,423(3.3%)暴露于早期使用氯胺酮。经过倾向评分匹配,每组1390例患者,氯胺酮输注的接受者与较高的医院死亡率相关(52.5%与45.9%,风险比:1.14,[1.06-1.23]),ICU住院时间中位数更长(13vs.12d,平均比率[MR]:1.15[1.08-1.23]),和更长的呼吸机天数(12vs.11d,MR:1.19[1.12-1.27])。医院LOS没有关联(17[10-27]与17[9-28],MR:1.05[0.99-1.12]),血管加压药天数(4vs.4,MR:1.04[0.95-1.14]),和RRT(22.9%与21.7%,RR:1.05[0.92-1.21])。医院总费用较高(中位数为72,481美元,而不是65,584美元,MR:1.11[1.05-1.19])。
结论:在不同的美国医院样本中,接受COVID-19机械通气的30例患者中约有1例接受氯胺酮输注.早期氯胺酮可能与更高的医院死亡率有关,增加了总成本,ICU停留,和呼吸机日,但没有医院LOS的关联,血管加压药天,和RRT。然而,由于氯胺酮组使用较高的体外膜氧合和RRT,可能会混淆疾病的严重程度。需要进一步的随机试验来更好地了解氯胺酮输注在危重患者管理中的作用。
OBJECTIVE: To describe the utilization of early ketamine use among patients mechanically ventilated for COVID-19, and examine associations with in-hospital mortality and other clinical outcomes.
METHODS: Retrospective cohort
study.
METHODS: Six hundred ten hospitals contributing data to the Premier Healthcare Database between April 2020 and June 2021.
METHODS: Adults with COVID-19 and greater than or equal to 2 consecutive days of mechanical ventilation within 5 days of hospitalization.
METHODS: The exposures were early ketamine use initiated within 2 days of intubation and continued for greater than 1 day.
METHODS: Primary was hospital mortality. Secondary outcomes included length of stay (LOS) in the hospital and ICUs, ventilator days, vasopressor days, renal replacement therapy (RRT), and total hospital cost. The propensity score matching analysis was used to adjust for confounders.
RESULTS: Among 42,954 patients, 1,423 (3.3%) were exposed to early ketamine use. After propensity score matching including 1,390 patients in each group, recipients of ketamine infusions were associated with higher hospital mortality (52.5% vs. 45.9%, risk ratio: 1.14, [1.06-1.23]), longer median ICU stay (13 vs. 12 d, mean ratio [MR]: 1.15 [1.08-1.23]), and longer ventilator days (12 vs. 11 d, MR: 1.19 [1.12-1.27]). There were no associations for hospital LOS (17 [10-27] vs. 17 [9-28], MR: 1.05 [0.99-1.12]), vasopressor days (4 vs. 4, MR: 1.04 [0.95-1.14]), and RRT (22.9% vs. 21.7%, RR: 1.05 [0.92-1.21]). Total hospital cost was higher (median $72,481 vs. $65,584, MR: 1.11 [1.05-1.19]).
CONCLUSIONS: In a diverse sample of U.S. hospitals, about one in 30 patients mechanically ventilated with COVID-19 received ketamine infusions. Early ketamine may have an association with higher hospital mortality, increased total cost, ICU stay, and ventilator days, but no associations for hospital LOS, vasopressor days, and RRT. However, confounding by the severity of illness might occur due to higher extracorporeal membrane oxygenation and RRT use in the ketamine group. Further randomized trials are needed to better understand the role of ketamine infusions in the management of critically ill patients.