Effects of Ketamine Infusion on Breathing and Encephalography in Spontaneously Breathing ICU Patients

Affiliation
Department of Anesthesia, Critical Care & Pain Medicine,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Suleiman, Aiman;
Affiliation
Department of Anesthesia, Critical Care & Pain Medicine,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Santer, Peter;
Affiliation
Department of Anesthesia, Critical Care & Pain Medicine,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Munoz-Acuna, Ronny;
Affiliation
Department of Anesthesia, Critical Care & Pain Medicine,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Hammer, Maximilian;
Affiliation
Department of Anesthesia, Critical Care & Pain Medicine,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Schaefer, Maximilian S.;
Affiliation
Department of Anesthesia, Critical Care & Pain Medicine,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Wachtendorf, Luca J.;
Affiliation
Pharmacy,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Rumyantsev, Sandra;
Affiliation
Department of Anesthesia, Critical Care and Pain Medicine,Massachusetts General Hospital ,Harvard Medical School , Boston, MA, USA
Berra, Lorenzo;
Affiliation
Department of Anesthesia, Critical Care and Pain Medicine,Massachusetts General Hospital ,Harvard Medical School , Boston, MA, USA
Chamadia, Shubham;
Affiliation
Department of Anesthesia, Critical Care and Pain Medicine,Massachusetts General Hospital ,Harvard Medical School , Boston, MA, USA
Johnson-Akeju, Oluwaseun;
Affiliation
Department of Medicine, Division of Pulmonary and Critical Care,Beth Israel Deaconess Medical Center ,Harvard Medical School , Boston, MA, USA
Baedorf-Kassis, Elias N.;
GND
1224491335
ORCID
0000-0002-7893-0596
LSF
12795
Affiliation
Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
Eikermann, Matthias

Background: Preclinical studies suggest that ketamine stimulates breathing. We investigated whether adding a ketamine infusion at low and high doses to propofol sedation improves inspiratory flow and enhances sedation in spontaneously breathing critically ill patients.

Methods: In this prospective interventional study, twelve intubated, spontaneously breathing patients received ketamine infusions at 5 mcg/kg/min, followed by 10 mcg/kg/min for 1 h each. Airway flow, pressure, and esophageal pressure were recorded during a spontaneous breathing trial (SBT) at baseline, and during the SBT conducted at the end of each ketamine infusion regimen. SBT consisted of one-minute breathing with zero end-expiratory pressure and no pressure support. Changes in inspiratory flow at the pre-specified time points were assessed as the primary outcome. Ketamine-induced change in beta-gamma electroencephalogram power was the key secondary endpoint. We also analyzed changes in other ventilatory parameters respiratory timing, and resistive and elastic inspiratory work of breathing.

Results: Ketamine infusion of 5 and 10 mcg/kg/min increased inspiratory flow (median, IQR) from 0.36 (0.29-0.46) L/s at baseline to 0.47 (0.32-0.57) L/s and 0.44 (0.33-0.58) L/s, respectively ( p  = .013). Resistive work of breathing decreased from 0.4 (0.1-0.6) J/l at baseline to 0.2 (0.1-0.3) J/l after ketamine 10 mcg/kg/min ( p  = .042), while elastic work of breathing remained unchanged. Electroencephalogram beta-gamma power (19-44 Hz) increased compared to baseline ( p  < .01). Conclusions In intubated, spontaneously breathing patients receiving a constant rate of propofol, ketamine increased inspiratory flow, reduced inspiratory work of breathing, and was associated with an “activated” electroencephalographic pattern. These characteristics might facilitate weaning from mechanical ventilation.

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