Evidence map›Paper›PMID 37160847›Full record

Observational studyNeurocritical care2024

Ketamine Use in the Intubation of Critically Ill Children with Neurological Indications: A Multicenter Retrospective Analysis.

Mervin V Loi, Jan Hau Lee, Jimmy W Huh, Palen Mallory, Natalie Napolitano, Justine Shults, Conrad Krawiec, Asha Shenoi, Lee Polikoff, Awni Al-Subu and 24 more

Abstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.1field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 6 citations in OpenAlex.

  1. Sedation Vacations in Neurocritical Care: Friend or Foe?Current neurology and neuroscience reports · 2024
    Review
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

34 authors at 20 institutions in 6 countries.

Mervin V LoiDepartment of Pediatric Subspecialties, Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore. mervin.loi.v.t@singhealth.com.sg.ORCID 0000-0002-2739-8245
Jan Hau LeeDepartment of Pediatric Subspecialties, Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.
Jimmy W HuhDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Palen MalloryDepartment of Pediatric Critical Care Medicine, Duke Children's Hospital and Health Center, Durham, NC, USA.
Natalie NapolitanoRespiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Justine ShultsDepartment of Biostatistics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Conrad KrawiecDepartments of Pediatric Critical Care Medicine and Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA.
Asha ShenoiDepartment of Pediatrics, University of Kentucky, Lexington, KY, USA.
Lee PolikoffDepartment of Pediatric Critical Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Awni Al-SubuDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
Ronald SandersDivision of Critical Care Medicine, Arkansas Children's Hospital, Little Rock, AR, USA.
Megan ToalDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
Aline BrancaDepartment of Pediatric Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.
Lily Glater-WeltDepartment of Pediatric Critical Care Medicine, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
Laurence Ducharme-CrevierDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada.
Ryan BreuerDivision of Critical Care Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, Buffalo, NY, USA.
Simon ParsonsSection of Critical Care Medicine, Alberta Children's Hospital, Calgary, Canada.
Ilana Harwayne-GidanskyDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical College, Albany, NY, USA.
Serena KellyDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Oregon Health and Science University Doernbecher Children's Hospital, Portland, OR, USA.
Makoto MotomuraDivision of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Aichi, Japan.
Kelsey GladenDepartment of Pediatric Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.
Matthew PintoDepartment of Pediatrics, New York Medical College, Valhalla, NY, USA.
John GiulianoSection of Pediatric Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
Gokul BysaniDepartment of Pediatrics, Medical City Children's Hospital, Dallas, TX, USA.
John BerkenboschDepartment of Pediatric Critical Care, University of Louisville and Norton Children's Hospital, Louisville, KY, USA.
Katherine BiagasDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
Kyle RehderDivision of Pediatric Critical Care, Duke Children's Hospital, Durham, NC, USA.
Mioko KasagiDivision of Pediatric Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Anthony LeeDivision of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Philipp JungDepartment of Pediatrics, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
Rakshay ShettyPediatric Intensive Care, Rainbow Children's Hospital, Bengaluru, India.
Vinay NadkarniDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Akira NishisakiDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
National Emergency Airway Registry for Children (NEAR4KIDS) Investigators, Pediatric Acute Lung Injury, Sepsis Investigators (PALISI) Network
Children's Hospital of Philadelphia · USDuke Children's Hospital & Health Center · USKK Women's and Children's Hospital · SGPhoenix Children's Hospital · USAlbany Medical Center Hospital · USAlberta Children's Hospital · CAArkansas Children's Hospital · USBrown University · USCentre Hospitalier Universitaire Sainte-Justine · CACohen Children's Medical Center · USCornell University · USMedical City Children's Hospital · USNationwide Children's Hospital · USNew York Medical College · USOregon Health & Science University · USPenn State Milton S. Hershey Medical Center · USRainbow Children's Hospital · INStony Brook School · USTokyo Metropolitan Children's Medical Center · JPUniversity Hospital Schleswig-Holstein · DE

Funding

AHRQ HHS R18HS022464AHRQ HHS R18HS024511Children's Hospital of Philadelphia Critical Care MedicineChildren's Hospital of Philadelphia Endowed Chair
6 · The paper itself

Abstract

backgroundKetamine has traditionally been avoided for tracheal intubations (TIs) in patients with acute neurological conditions. We evaluate its current usage pattern in these patients and any associated adverse events.

methodsWe conducted a retrospective observational cohort study of critically ill children undergoing TI for neurological indications in 53 international pediatric intensive care units and emergency departments. We screened all intubations from 2014 to 2020 entered into the multicenter National Emergency Airway Registry for Children (NEAR4KIDS) registry database. Patients were included if they were under the age of 18 years and underwent TI for a primary neurological indication. Usage patterns and reported periprocedural composite adverse outcomes (hypoxemia < 80%, hypotension/hypertension, cardiac arrest, and dysrhythmia) were noted.

resultsOf 21,562 TIs, 2,073 (9.6%) were performed for a primary neurological indication, including 190 for traumatic brain injury/trauma. Patients received ketamine in 495 TIs (23.9%), which increased from 10% in 2014 to 41% in 2020 (p < 0.001). Ketamine use was associated with a coindication of respiratory failure, difficult airway history, and use of vagolytic agents, apneic oxygenation, and video laryngoscopy. Composite adverse outcomes were reported in 289 (13.9%) Tis and were more common in the ketamine group (17.0% vs. 13.0%, p = 0.026). After adjusting for location, patient age and codiagnoses, the presence of respiratory failure and shock, difficult airway history, provider demographics, intubating device, and the use of apneic oxygenation, vagolytic agents, and neuromuscular blockade, ketamine use was not significantly associated with increased composite adverse outcomes (adjusted odds ratio 1.34, 95% confidence interval CI 0.99-1.81, p = 0.057). This paucity of association remained even when only neurotrauma intubations were considered (10.6% vs. 7.7%, p = 0.528).

conclusionsThis retrospective cohort study did not demonstrate an association between procedural ketamine use and increased risk of peri-intubation hypoxemia and hemodynamic instability in patients intubated for neurological indications.

Indexed as

KetamineRespiratory InsufficiencyAdolescentChildCritical IllnessHumansHypoxiaIntubation, IntratrachealRetrospective StudiesKetamineAdverse eventsChildCritical illnessEndotracheal intubationKetamineNeurologyTraumatic brain injury

Identifiers

PMID37160847
OpenAlexW4376104756

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.