Emergency department use of ketamine in pediatric status asthmaticus

The objective of this study was to evaluate the effects of adding ketamine to standard emergency department (ED) therapy for patients with status asth maticus. This was a prospective observational study. Ten patients with an a cute exacerbation of asthma who were unresponsive to standard therapy were enrolled in the ED. Upon enrollment, children received ketamine at a loadin g dose of I mg/kg intravenously (i.v.), followed by a continuous infusion o f 0.75 mg/kg/hr (12.5 mug/kg/min) for 1 hr. Clinical asthma score (CAS), vi tal signs, and peak expiratory flow (PEF) measurements were obtained prior to ketamine administration, within 10 min after ketamine administration was completed, and I hr after infusion. Median CAS on ED arrival was 15 (range 7-23) and did not significantly change immediately prior to infusion of ke tamine (median 14, range 8-21). Median CAS decreased to 10.5 immediately af ter infusion and to 9.51 hr post ketamine infusion (37% reduction, p < 0.05 by ANOVA vs. preketamine CAS). Median respiratory rate (RR) also decreased from 39 prior to ketamine to 30 immediately following ketamine administrat ion (25% decrease vs. preketamine; p < 0.05). Oxygen saturation significant ly improved after ketamine infusion, although 5 patients remained on oxygen . Median PEF improved after infusion, but tvas not statistically significan t. Four patients experienced mild side effects including mild hallucination s, diffuse flushing, and moderate hypertension. Side effects resolved vith benzodiazepines or with discontinuation of the infusion. Addition of ketami ne to standard therapy, was associated with improved indices of acute asthm a severity. Side effects were transitory and comparable to previous studies . However. a double-blinded randomized controlled trial needs to he conduct ed to determine if improvement is attributable to the addition of ketamine to standard asthma therapy.