Comparing the hemodynamic effects of ketamine versus fentanyl bolus in patients with septic shock: a randomized controlled trial.
Journal of anesthesia – December 01, 2024
Source: PubMed
Summary
In critical care settings, choosing the right sedation medication can significantly impact patient outcomes. Ketamine showed remarkable benefits over fentanyl in patients with septic shock, increasing cardiac output by 71% compared to a 31% decrease with fentanyl. The research tracked vital signs in mechanically ventilated patients, revealing ketamine's superior ability to maintain stable blood pressure and heart function during sedation.
Abstract
Ketamine and fentanyl are commonly used for sedation and induction of anesthesia in critically ill patients. This study aimed to compare the hemodynamic effects of ketamine versus fentanyl bolus in patients with septic shock. This randomized controlled trial included mechanically ventilated adults with septic shock receiving sedation. Patients were randomized to receive either 1 mg/kg ketamine bolus or 1 mcg/kg fentanyl bolus. Cardiac output (CO), stroke volume (SV), heart rate (HR), and mean arterial pressure (MAP) were measured at the baseline, 3, 6, 10, and 15 min after the intervention. Delta CO was calculated as the change in CO at each time point in relation to baseline measurement. The primary outcome was delta CO 6 min after administration of the study drug. Other outcomes included CO, SV, HR, and MAP. Eighty-six patients were analyzed. The median (quartiles) delta CO 6 min after drug injection was 71(37, 116)% in the ketamine group versus - 31(- 43, - 12)% in the fentanyl group, P value < 0.001. The CO, SV, HR, and MAP increased in the ketamine group and decreased in the fentanyl group in relation to the baseline reading; and all were higher in the ketamine group than the fentanyl group. In patients with septic shock, ketamine bolus was associated with higher CO and SV compared to fentanyl bolus. Date of registration: 24/07/2023. gov Identifier: NCT05957302. URL: https://clinicaltrials.gov/study/NCT05957302 .