Dexmedetomidine versus ketamine in improving tolerance to noninvasive ventilation after blunt chest trauma: A randomized, double-blinded, placebo-controlled trial.
Huda F Ghazaly, Mohamed M Elansary, Ahmed A Mahmoud, Mohamed K Hasanen, Mahmoud M Hassan
Journal of anaesthesiology, clinical pharmacology January 1, 2024 DOI: 10.4103/joacp.joacp_145_23 via PubMed
Summary
AI-generated from the abstractIn a randomized, double-blinded, placebo-controlled trial of 45 adults aged 18–60 with blunt chest trauma requiring noninvasive ventilation (NIV), dexmedetomidine produced significantly longer mean NIV session duration compared to placebo, but not compared to ketamine. Dexmedetomidine led to deeper sedation (lower Richmond Agitation Sedation Scale scores) than both ketamine and placebo. Ketamine provided better pain control (lower Visual Analog Scale scores) and required significantly less rescue morphine than the other groups. The findings suggest that while both sedatives improve NIV tolerance over placebo, each offers distinct advantages: dexmedetomidine for sedation and ketamine for analgesia with less opioid use.
Study at a glance
| Characteristics | Randomized controlled trial Placebo-controlled Double-blind Peer reviewed |
|---|---|
| Sample size | 45 |
| Population | Adults aged 18–60 with blunt chest trauma needing noninvasive ventilation |
| Interventions | Dexmedetomidine Ketamine Placebo (0.9% sodium chloride solution) |
| Duration | Two successive NIV sessions |
| Topics | Ketamine |
| Keywords | Blunt chest trauma Dexmedetomidine Non-invasive ventilation Pain management |
| Citations | 1 |
| Key finding | Dexmedetomidine did not significantly lengthen NIV sessions compared to ketamine, but both sedatives improved tolerance over placebo, with dexmedetomidine providing deeper sedation and ketamine offering better pain control and less rescue morphine. |
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.