Ketamine use for endotracheal intubation in severe sepsis and septic shock

Abstract

Objective. We conducted this study to evaluate the clinical outcomes of patients with severe sepsis and septic shock who were treated with ketamine for endotra-cheal intubation.Methods. A single-center, retrospective study was carried out to compare the out-comes of patients with severe sepsis and septic shock who received a ketamine or non-ketamine agent for rapid sequence intubation (RSI). We analyzed the sepsis registry for adult patients who presented to the emergency department (ED), met the criteria for severe sepsis or septic shock, and underwent endotracheal intubation between August 2008 and March 2014. The primary outcome was 28-day mortal-ity. We performed a multivariable logistic regression analysis to assess the association between ketamine use for intubation and 28-day mortality.Results. In all, 170 patients were intubated during the study period. Of the eligible patients, 95 received ketamine and 75 re-ceived a non-ketamine agent. The 28-day mortality of the ketamine group was not significantly different from that of the non-ketamine group (38% vs. 40%, respectively, P=0.78). The unadjusted odds ratio (OR) of ketamine use for 28-day mortality was 0.92 (95% CI: 0.49–1.70, P=0.78). The as-sociation remained insignificant after ad-justing for age, gender, malignancy, initial lactate level on ED admission, time to first antibiotic administration, Acute Physiolo-gy and Chronic Health Evaluation II score on admission day, and propensity score re-garding ketamine use (adjusted OR: 1.09; 95% confidence interval [CI]: 0.49–2.40;P=0.84). Initial serum lactate on ED ad-mission was the only significant predictive factor of 28-day mortality (adjusted OR: 1.23; 95% CI: 1.10–1.38; P<0.01). Conclusions. For patients with severe sep-sis and septic shock who were intubated using RSI, we found no significant differ-ence in 28-day mortality between those who received ketamine as a sedative agent and those who received alternative seda-tives.