Ketamine Sedation in the Intensive Care Unit: A Survey, Systematic Review, Network Meta-analysis, and Pilot Study Protocol
Notice bibliographique
Résumé
This thesis consists of two studies presented as two separate manuscripts (one has been published in a peer-reviewed journal and the other is in the process of being submitted to a peer-reviewed journal) and a protocol for a pilot randomized controlled trial. The overarching aim of this thesis was to explore the evidence examining the use of ketamine as a sedative for critically ill mechanically ventilated patients in the Intensive Care Unit (ICU). We conducted a national survey to understand the beliefs and practices of Canadian ICU physicians regarding the use of ketamine as a continuous intravenous sedative in critically ill patients and to gauge interest in participating in a randomized controlled trial (RCT). We surveyed 400 physician members of the Canadian Critical Care Society and found that most respondents rarely use ketamine as a continuous infusion for sedation or analgesia in the ICU. We found that there were a number of clinical circumstances that would make physicians more likely to use ketamine such as asthma exacerbation and established tolerance to opioids. Conversely, physicians were concerned about the potential side effects of ketamine, particularly psychotropic effects including delirium. Overall, the majority of physicians surveyed agreed that there is a need for a clinical trial to evaluate the effectiveness and safety of ketamine as a sedative infusion in the ICU. The results of this survey informed the second manuscript which is a systematic review examining the use of procedural sedation medications in acutely ill patients. Prospective data examining ketamine as a continuous sedative in critically ill patients is sparse and insufficient for pooled analysis. Therefore, we focused on an indirect source of evidence, the role of ketamine as a procedural sedation drug. In order to summarize this data, we performed a systematic review and network meta-analysis (NMA) comparing all peri-procedural sedative drugs in acutely ill patients. The NMA provides the ability to include indirect data into the pooled point estimates. We performed a search of multiple databases and found 82 RCTs (8,105 patients) that met eligibility criteria, 78 conducted in the Emergency Department and 4 in the ICU. Compared to alternative medications, we found that ketamine was associated with the fewest respiratory adverse events based on high certainty evidence. Furthermore, we found that combining ketamine with propofol resulted in the highest patient satisfaction (high certainty) and the fewest cardiac adverse events (low certainty). The final component of this thesis is a pilot RCT protocol examining the feasibility of a larger RCT assessing the efficacy and safety of an adjunctive ketamine continuous infusion in mechanically ventilated ICU patients. We plan to submit this protocol for peer-reviewed funding as a first step to address this clinically important question.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,083 | 0,111 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,006 |
| Méta-épidémiologie (sens large) | 0,010 | 0,014 |
| Bibliométrie | 0,009 | 0,009 |
| Études des sciences et des technologies | 0,003 | 0,003 |
| Communication savante | 0,005 | 0,005 |
| Science ouverte | 0,004 | 0,004 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,046 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».