Photo Credit: Ninitta

The following is a summary of the study “Can ketamine administration prevent intubation in patients who cannot comply with NIV due to agitation?” published in the October 2024 issue of Emergency Medicine by Nuhoğlu et al.

In the emergency department, patients with acute respiratory failure often require non-invasive mechanical ventilation (NIMV) when standard oxygen support is insufficient. However, patients experiencing agitation frequently struggle to comply with NIMV, leading to a higher need for invasive mechanical ventilation (IMV). 

For a study, researchers sought to determine whether ketamine, as a sedative agent, could help improve compliance with NIMV and reduce the rate of intubation in such patients. They conducted a retrospective review of patients admitted to the emergency department between 2021 and 2022 with acute respiratory failure and evaluated their agitation levels using the Richmond Agitation Sedation Scale (RASS). Their goal was to evaluate the link between ketamine administration and NIMV compliance and the impact on intubation rates.

The study included 81 patients, 35 (43.2%) men and 46 (56.8%) women. Of these patients, 46 (56.8%) required intubation despite receiving ketamine, while 35 (43.2%) were able to comply with NIMV and avoid intubation. A significant difference in agitation levels was noted between the two groups: the non-intubated group had a RASS score of 2.17 ± 0.68, while the intubated group scored higher at 2.66 ± 0.73 (p = 0.003).

They concluded that while agitation can severely impair NIMV compliance, a notable portion of these patients may avoid invasive mechanical ventilation through the use of appropriate sedative agents like ketamine. It means ketamine could be an effective strategy in managing patients with acute respiratory failure who struggle with agitation during NIMV.

Source: bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01100-z