Dexmedetomidine and ketamine infusions improve patient tolerance during noninvasive ventilation after chest trauma, Study finds

Research on using sedation to improve patient tolerance to noninvasive ventilation (NIV) after traumatic chest injuries is scarce, despite its crucial role in the success of NIV. Recent randomized, double-blind, placebo-controlled study investigated the use of dexmedetomidine and ketamine to improve patient tolerance and duration of noninvasive ventilation (NIV) in patients with blunt chest trauma.

The study included 45 patients aged 18-60 years who required NIV after blunt chest trauma. Patients were randomly assigned to receive a continuous intravenous infusion of dexmedetomidine, ketamine, or placebo (0.9% saline) during two successive NIV sessions. The key findings were: 1. The mean duration of the NIV sessions was significantly longer in the dexmedetomidine (309.6 ± 63.5 and 290.5 ± 43.2 minutes) and ketamine (291.0 ± 56.2 and 288.8 ± 59.6 minutes) groups compared to placebo (200.7 ± 46.9 and 187.0 ± 76.7 minutes), but there was no significant difference between the dexmedetomidine and ketamine groups. 2. The dexmedetomidine group had significantly lower Richmond Agitation Sedation Scale (RASS) scores compared to the ketamine and placebo groups, indicating a deeper level of sedation. 3. The ketamine group had significantly lower Visual Analog Scale (VAS) pain scores and required less total morphine compared to the dexmedetomidine and placebo groups. 4. There was a significant negative correlation between the NIV session durations and the VAS and RASS scores. 5. Blood pressure was significantly lower in the dexmedetomidine group compared to the ketamine and placebo groups, while heart rate was lower in the dexmedetomidine group versus ketamine during the second session. 6. Oxygenation parameters (PaO2 and PaO2/FiO2 ratio) were significantly better in the dexmedetomidine and ketamine groups compared to placebo. In conclusion, both dexmedetomidine and ketamine improved patient tolerance and increased the duration of NIV sessions compared to placebo in blunt chest trauma patients. However, the duration did not differ significantly between the two drug groups. Dexmedetomidine provided deeper sedation, while ketamine provided better pain control.

Key Points

Based on the research paper summary provided, the 6 key points are:

1. The mean duration of the NIV sessions was significantly longer in the dexmedetomidine and ketamine groups compared to the placebo group, but there was no significant difference between the dexmedetomidine and ketamine groups.

2. The dexmedetomidine group had significantly lower Richmond Agitation Sedation Scale (RASS) scores compared to the ketamine and placebo groups, indicating a deeper level of sedation.

3. The ketamine group had significantly lower Visual Analog Scale (VAS) pain scores and required less total morphine compared to the dexmedetomidine and placebo groups.

4. There was a significant negative correlation between the NIV session durations and the VAS and RASS scores.

5. Blood pressure was significantly lower in the dexmedetomidine group compared to the ketamine and placebo groups, while heart rate was lower in the dexmedetomidine group versus ketamine during the second session.

6. Oxygenation parameters (PaO2 and PaO2/FiO2 ratio) were significantly better in the dexmedetomidine and ketamine groups compared to placebo.

Reference –

Ghazaly HF, Elansary MM, Mahmoud AA, Hasanen MK, Hassan MM. Dexmedetomidine versus ketamine in improving tolerance to noninvasive ventilation after blunt chest trauma: A randomized, double‑blinded, placebo‑controlled trial. J Anaesthesiol Clin Pharmacol 2024. DOI: 10.4103/joacp.joacp_145_23