Prospective, randomized, controlled trial comparing PROpofol versus KetaMINE in rapid sequence intubation in critically ill patients (PROMINE): protocol paper and statistical analysis plan.
Critical care science – January 01, 2025
Source: PubMed
Summary
Choosing the safest medication for critically ill patients needing breathing tube insertion is a critical decision. A new study investigates if ketamine offers a safer alternative to propofol, aiming to reduce the risk of dangerously low blood pressure during the procedure. Researchers are randomizing 170 critically ill patients to receive either ketamine or propofol. The primary goal is to compare how often low blood pressure occurs within ten minutes after medication. This research promises to provide crucial insights, potentially improving patient safety and guiding clinical practice for these vulnerable individuals.
Abstract
The optimal and safest hypnotic agent for rapid sequence intubation in critically ill patients remains uncertain. Factors such as hypovolemia, vasoplegia, hypoxemia, and acidosis can influence the efficacy and safety of induction agents. Propofol is commonly used for this purpose; however, it is associated with the risk of exacerbating hypotension. Ketamine, which has a more favorable hemodynamic profile, may offer a safer alternative in these patients. To assess whether ketamine is a safer alternative to propofol for rapid sequence intubation by reducing the incidence of hypotension during induction in critically ill patients. This will be a randomized, open-label, pragmatic, bicenter study. A total of 170 critically ill patients requiring endotracheal intubation in the intensive care unit will be randomly assigned to receive either ketamine or propofol as the hypnotic agent. Randomization will be conducted using RedCap with a 1:1 ratio and variable block sizes, stratified by study site and vasopressor use during intubation. The primary outcome will be the occurrence of hypotension, defined as the lowest mean arterial pressure recorded within the first 10 minutes following induction. Secondary outcomes, assessed within 1-hour post-induction, include mortality, incidence of cardiopulmonary arrest, the occurrence of severe hypotension (systolic blood pressure < 80mmHg), the occurrence of severe hypoxemia (oxygen saturation < 85%), and the number of intubation attempts. The PROMINE study will provide valuable evidence to guide the selection of hypnotic agents for rapid sequence intubation in critically ill patients. It will contribute to a better understanding of the hemodynamic effects associated with propofol and ketamine in this context, potentially informing clinical practice.