Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events

Abstract

Objectives: Tracheal intubation in critically ill children with shock poses a risk of hemodynamic compromise. Ketamine has been considered the drug of choice for induction in these patients, but limited data exist. We investigated whether the administration of ketamine for tracheal intubation in critically ill children with or without shock was associated with fewer adverse hemodynamic events compared with other induction agents. We also investigated if there was a dose dependence for any association between ketamine use and adverse hemodynamic events. Design: We performed a retrospective analysis using prospectively collected observational data from the National Emergency Airway Registry for Children database from 2013 to 2017. Setting: Forty international PICUs participating in the National Emergency Airway Registry for Children. Patients: Critically ill children 0–17 years old who underwent tracheal intubation in a PICU. Interventions: None. Measurements and Main Results: The association between ketamine exposure as an induction agent and the occurrence of adverse hemodynamic events during tracheal intubation including dysrhythmia, hypotension, and cardiac arrest was evaluated. We used multivariable logistic regression to account for patient, provider, and practice factors with robust ses to account for clustering by sites. Of 10,750 tracheal intubations, 32.0% (n = 3,436) included ketamine as an induction agent. The most common diagnoses associated with ketamine use were sepsis and/or shock (49.7%). After adjusting for potential confounders and sites, ketamine use was associated with fewer hemodynamic tracheal intubation associated adverse events compared with other agents (adjusted odds ratio, 0.74; 95% CI, 0.58–0.95). The interaction term between ketamine use and indication for shock was not significant (p = 0.11), indicating ketamine effect to prevent hemodynamic adverse events is consistent in children with or without shock. Conclusions: Ketamine use for tracheal intubation is associated with fewer hemodynamic tracheal intubation–associated adverse events.

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

“…e children's nutritional risks have not been screened in time. us, the malnutrition of critically ill children is neglected [10][11][12][13] X ± s). e horizontal axis from left to right represents before intervention and after intervention, and the vertical axis represents the IgG level (μmol/L).…”

Comparison of general endotracheal anesthesia versus sedation without endotracheal intubation during initial percutaneous endoscopic gastrostomy insertion for infants: A retrospective cohort study

“…When used in combination with propofol, ketamine has the added benefit of providing analgesia while limiting respiratory depression and improving respiratory symptoms like bronchospasm. Using ketamine in combination with propofol also reduces cardiovascular depression 36,37 . Given the similar medication use in both groups, it can be inferred that the primary difference in the anesthetic management of MAC or GETA patients was their intubation status.…”

“…Using ketamine in combination with propofol also reduces cardiovascular depression. 36,37 Given the similar medication use in both groups, it can be inferred that the primary difference in the anesthetic management of MAC or GETA patients was their intubation status.…”

Peri-Intubation Adverse Events in the Critically Ill Child After Hematopoietic Cell Transplant

“…The primary outcome was hemodynamic TIAE and/or peri-intubation hypoxemia (Spo 2 < 80%) during the TI procedure, as validated in other studies (15,17,18). The hemodynamic TIAE were defined as hyper-or hypotension requiring intervention, dysrhythmia, or cardiac arrest with or without return of spontaneous circulation.…”