Dataset Information

Ketamine-based Versus Fentanyl-based Regimen for Rapid-sequence Endotracheal Intubation in Patients with Septic Shock: A Randomised Controlled Trial.

ABSTRACT:

Objective

The aim of this work is to compared ketamine-based versus fentanyl-based regimens for endotracheal intubation in patients with septic shock undergoing emergency surgery.

Design

This was a randomised double-blinded controlled trial.

Participants

Patients with septic shock on norepinephrine infusion scheduled for emergency surgery.

Setting and interventions

At induction of anaesthesia, patients were allocated into ketamine group (n=23) in which the participants received ketamine 1 mg/kg, and fentanyl group (n=19) in which the participants received fentanyl 2.5 mcg/ kg. Both groups received midazolam (0.05 mg/kg) and succinyl choline (1 mg/kg).

Measurement

The primary outcome was mean arterial blood pressure. The secondary outcomes included: heart rate, cardiac output, and incidence of postintubation hypotension defined as mean arterial pressure ≤80% of baseline value.

Results

Forty-two patients were available for final analysis. The mean blood pressure was higher in the ketamine group than in the fentanyl group at 1, 2 and 5 minutes after the induction of anaesthesia. Furthermore, the incidence of postinduction hypotension was lower in the ketamine group than in the fentanyl group (11 [47.8%] versus 16 [84.2%], P-value= 0.014). Other hypodynamic parameters, namely the heart rate and cardiac output, were comparable between both groups; and were generally maintained in relation to the baseline reading in each group.

Conclusion

The ketamine-based regimen provided better hemodynamic profile compared to fentanyl-based regimen for rapid-sequence intubation in patients with septic shock undergoing emergency surgery.

SUBMITTER: Ali H

PROVIDER: S-EPMC9949025 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Ketamine-based Versus Fentanyl-based Regimen for Rapid-sequence Endotracheal Intubation in Patients with Septic Shock: A Randomised Controlled Trial.

Ali Hassan H Abdelhamid Bassant Mohamed BM Hasanin Ahmed M AM Amer Aya Abou AA Rady Ashraf A

Romanian journal of anaesthesia and intensive care 20211201 2

<h4>Objective</h4>The aim of this work is to compared ketamine-based versus fentanyl-based regimens for endotracheal intubation in patients with septic shock undergoing emergency surgery.<h4>Design</h4>This was a randomised double-blinded controlled trial.<h4>Participants</h4>Patients with septic shock on norepinephrine infusion scheduled for emergency surgery.<h4>Setting and interventions</h4>At induction of anaesthesia, patients were allocated into ketamine group (n=23) in which the participan ...[more]

PMID: 36844112

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Project description:BackgroundAcute respiratory failure in septic patients contributes to higher in-hospital mortality. Intubation may improve outcome but there are no specific criteria for intubation. Intubation of septic patients with respiratory distress and hemodynamic compromise may result in clinical deterioration and precipitate cardiovascular failure. The decision to intubate is complex and multifactorial. The purpose of this study was to evaluate the impact of intubation in patients with respiratory distress and predominant hemodynamic instability within 24 h after ICU admission for septic shock.MethodsWe conducted a retrospective analysis of a prospective registry of adult patients with septic shock admitted to the medical ICU at Mayo Clinic, between April 30, 2014 and December 31, 2017. Septic shock was defined by persistent lactate > 4 mmol/L, mean arterial pressure < 65 mmHg, or vasopressor use after 30 mL/kg fluid boluses and suspected or confirmed infection. Patients who remained hospitalized in the ICU at 24 h were separated into intubated while in the ICU and non-intubated groups. The primary outcome was hospital mortality. The first analysis used linear regression models and the second analysis used time-dependent propensity score matching to match intubated to non-intubated patients.ResultsOverall, 358 (33%) ICU patients were eventually intubated after their ICU admission and 738 (67%) were not. Intubated patients were younger, transferred more often from an outside facility, more critically ill, had more lung infection, and achieved blood pressure goals more often, but lactate normalization within 6 h occurred less often. Among those who remained hospitalized in the ICU 24 h after sepsis diagnosis, the crude in-hospital mortality was higher in intubated than non-intubated patients, 89 (26%) vs. 82 (12%), p < 0.001, as was the ICU mortality and ICU and hospital length of stay. After adjustment, intubation showed no effect on hospital mortality but resulted in fewer hospital-free days through day 28. One-to-one propensity resulted in similar conclusion.ConclusionsIntubation within 24 h of sepsis was not associated with hospital mortality but resulted in fewer 28-day hospital-free days. Although intubation remains a high-risk procedure, we did not identify an increased risk in mortality among septic shock patients with predominant hemodynamic compromise.

Project description:ImportanceRocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Succinylcholine use has been associated with several adverse events not reported with rocuronium.ObjectiveTo assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations.Design, setting and participantsMulticenter, single-blind, noninferiority randomized clinical trial comparing rocuronium (1.2 mg/kg) with succinylcholine (1 mg/kg) for rapid sequence intubation in 1248 adult patients needing out-of-hospital tracheal intubation. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. The date of final follow-up was August 31, 2016.InterventionsPatients were randomly assigned to undergo tracheal intubation facilitated by rocuronium (n = 624) or succinylcholine (n = 624).Main outcomes and measuresThe primary outcome was the intubation success rate on first attempt. A noninferiority margin of 7% was chosen. A per-protocol analysis was prespecified as the primary analysis.ResultsAmong 1248 patients who were randomized (mean age, 56 years; 501 [40.1%] women), 1230 (98.6%) completed the trial and 1226 (98.2%) were included in the per-protocol analysis. The number of patients with successful first-attempt intubation was 455 of 610 (74.6%) in the rocuronium group vs 489 of 616 (79.4%) in the succinylcholine group, with a between-group difference of -4.8% (1-sided 97.5% CI, -9% to ∞), which did not meet criteria for noninferiority. The most common intubation-related adverse events were hypoxemia (55 of 610 patients [9.0%]) and hypotension (39 of 610 patients [6.4%]) in the rocuronium group and hypoxemia (61 of 616 [9.9%]) and hypotension (62 of 616 patients [10.1%]) in the succinylcholine group.Conclusions and relevanceAmong patients undergoing endotracheal intubation in an out-of-hospital emergency setting, rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate.Trial registrationClinicalTrials.gov Identifier: NCT02000674.

Dataset Information

Ketamine-based Versus Fentanyl-based Regimen for Rapid-sequence Endotracheal Intubation in Patients with Septic Shock: A Randomised Controlled Trial.

Objective

Design

Participants

Setting and interventions

Measurement

Results

Conclusion

Publications

Ketamine-based Versus Fentanyl-based Regimen for Rapid-sequence Endotracheal Intubation in Patients with Septic Shock: A Randomised Controlled Trial.

Similar Datasets

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