Ketamine Use allows Noninvasive Ventilation in Distressed Patients with Acute Decompensated Heart Failure.

Ankur Verma,Abhishek Snehy,Wasil Rasool Sheikh,Meghna Haldar,Amit Singh Vishen ,Sanjay Jaiswal

doi:10.5005/jp-journals-10071-23153

Ankur Verma, Abhishek Snehy + Show 4 more

Open Access

https://doi.org/10.5005/jp-journals-10071-23153

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Abstract

ABSTRACTAcute decompensated heart failure (ADHF) is responsible for a heavy clinical load on busy emergency departments (EDs) across the globe and especially in India. ADHF patients may present with severe respiratory distress, dyspnea, hypoxia, and high and low blood pressures. Managing the airway of such patients can at times be challenging. Nasal cannulae, face mask, and noninvasive positive pressure ventilation (NIPPV) are the cornerstones of providing oxygenation and ventilation to such patients while some extreme cases may require endotracheal intubation and mechanical ventilation.An elderly female in severe respiratory distress and altered sensorium presented to our ED and had to be administered ketamine to facilitate proper NIPPV and avoid mechanical ventilation. She was weaned off the NIPPV in the ED itself over the next four hours. There are some case reports of using ketamine for NIPPV in asthma exacerbations, but none for the use in ADHF. Avoiding invasive mechanical ventilation via endotracheal intubation should be a constant goal and the last resort.How to cite this article: Verma A, Snehy A, et al. Ketamine Use Allows Noninvasive Ventilation in Distressed Patients with Acute Decompensated Heart Failure. Indian J Crit Care Med 2019;23(4): 191–192.

Highlights

Any acute or insidious progression of heart failure (HF) requiring urgent medical attention is what defines Acute decompensated heart failure (ADHF).[1]
We describe a case where ketamine was used to allow compliance with noninvasive positive pressure ventilation (NIPPV) in a severely distressed patient of ADHF
Ketamine and NIPPV have been used in asthma exacerbations as a temporizing measure to avoid mechanical ventilation.[6]

Summary

Introduction

Any acute or insidious progression of heart failure (HF) requiring urgent medical attention is what defines ADHF.[1]. It is responsible for a heavy clinical load and increases the burden on healthcare and EDs across the globe. The acute failure registry (AFAR) study conducted in India showed a 38% mortality of ADHF patients admitted.[1]. Dyspnea is usually the most common symptom with which patients of ADHF present to the ED. Patients with ADHF presenting in respiratory distress will require stabilization of their airway and breathing.

Case History

Discussion