In recent years, ketamine has been recognized as a notable dissociative agent in the context of non-invasive ventilation (NIV), particularly for patients facing respiratory distress. Its unique pharmacological profile, which includes effective analgesic and sedative properties, renders it beneficial for patients in need of mechanical support or those at risk for intubation due to inadequate respiratory function. Studies highlight ketamine's role in reducing ventilator-induced dyssynchrony (VPD), which can be especially problematic in patients with acute respiratory distress syndrome (ARDS) (Wyler et al., 2023).
As a versatile anesthetic, ketamine not only deepens sedation but also serves as a valuable adjunct in analgo-sedation protocols, particularly minimizing the use of opioids and benzodiazepines (Wyler et al., 2023; Verma et al., 2019). The bronchodilator effects of ketamine further support its use in patients with respiratory compromise, including those suffering from severe asthma exacerbations (Shlamovitz & Hawthorne, 2011). Experimental and clinical evidence suggests that ketamine can relax bronchial smooth muscle, thereby improving ventilation parameters such as PaO2 and mean airway pressure, which are critical in NIV settings (Shlamovitz & Hawthorne, 2011). Moreover, its sedative efficacy can help facilitate the patient-ventilator interface during NIV, making it an attractive option in cases of decompensated chronic obstructive pulmonary disease (COPD) and acute heart failure (Verma et al., 2019; Bradshaw et al., 2019).
A study demonstrated that continuous ketamine infusion can effectively reduce the consumption of other sedatives while ensuring adequate sedation in critically ill patients (Buchheit et al., 2017). Furthermore, its use has been documented alongside dexmedetomidine, maximizing sedation while minimizing respiratory depression, a common concern in patients with compromised pulmonary function (Riccardi et al., 2023). The sedative doses typically range from low to moderate, which helps in achieving desired outcomes without the associated risks tied to traditional sedatives like benzodiazepines, which have significant side effects including delirium and prolonged mechanical ventilation (Haliloğlu, 2022).
Nevertheless, the risk of cholestatic liver injury associated with prolonged ketamine infusion in critically ill COVID-19 patients raises concerns about its long-term usage (Wendel‐Garcia et al., 2022). Despite these apprehensions, ketamine's application in acute settings—especially as a temporizing measure to avoid mechanical ventilation—continues to show promise (Shlamovitz & Hawthorne, 2011; Verma et al., 2019; . Clinical observations and trials emphasize that ketamine supports patient comfort during NIV and enhances overall tolerance, leading to better outcomes in respiratory management (Ghazaly et al., 2024; Verma et al., 2019; Bradshaw et al., 2019).
In conclusion, ketamine's multifaceted role as a dissociative anesthetic in non-invasive ventilation is evidenced by its analgesic, bronchodilatory, and sedative properties, making it an essential tool in critical care medicine for various patient populations. A thoughtful balance between its advantages and potential adverse effects is crucial for optimizing patient outcomes in respiratory emergencies.
References:
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