Dexmedetomidine versus ketamine in improving tolerance to noninvasive ventilation after blunt chest trauma: A randomized, double-blinded, placebo-controlled trial.
Journal of anaesthesiology, clinical pharmacology – January 01, 2024
Source: PubMed
Summary
Pain management after chest injuries presents unique challenges for breathing support. A breakthrough study compared two sedation medications for patients requiring breathing assistance after blunt chest trauma. Both dexmedetomidine and ketamine helped patients tolerate non-invasive ventilation longer than those receiving placebo. While dexmedetomidine provided better sedation, ketamine offered superior pain control with less need for additional pain medication.
Abstract
Even though patient tolerance is critical to the success of noninvasive ventilation (NIV), research on using sedation to improve tolerance to NIV after traumatic chest injuries is limited. We hypothesized that dexmedetomidine would be superior to ketamine in terms of patient tolerance and lengthening the NIV sessions after blunt chest trauma. This randomized, double-blinded, placebo-controlled trial included 45 patients of both genders aged 18-60 who needed NIV after blunt chest trauma. The patients were randomly assigned to one of three groups (n = 15) for receiving dexmedetomidine, ketamine, or placebo (0.9% sodium chloride solution) infusion to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and - 3 during two successive NIV sessions. Patients were evaluated for the duration of the NIV sessions, RASS, Visual Analog Scale (VAS), and the total amount of rescue analgesia consumed. The mean duration of the NIV sessions was significantly longer in patients who received dexmedetomidine (P 0.05). The dexmedetomidine group had a significantly lower RASS score compared to the ketamine (P < 0.001) and placebo (P < 0.001) groups, whereas the ketamine group had a significantly lower VAS compared to the dexmedetomidine (P = 0.005) and placebo (P = 0.022) groups and required significantly less total morphine (P = 0.001) compared to the other groups. The duration of the NIV sessions for patients with blunt chest trauma did not differ significantly between the dexmedetomidine and ketamine groups.