Comparing the hemodynamic effects of ketamine versus fentanyl bolus in patients with septic shock: a randomized controlled trial

Abstract

Background: Ketamine and fentanyl are commonly used for sedation and induction of anesthesia in critically ill patients. This study aimed to compare the hemodynamic effects of ketamine versus fentanyl bolus in patients with septic shock.

Methods: This randomized controlled trial included mechanically ventilated adults with septic shock receiving sedation. Patients were randomized to receive either 1 mg/kg ketamine bolus or 1 mcg/kg fentanyl bolus. Cardiac output (CO), stroke volume (SV), heart rate (HR), and mean arterial pressure (MAP) were measured at the baseline, 3, 6, 10, and 15 min after the intervention. Delta CO was calculated as the change in CO at each time point in relation to baseline measurement. The primary outcome was delta CO 6 min after administration of the study drug. Other outcomes included CO, SV, HR, and MAP.

Results: Eighty-six patients were analyzed. The median (quartiles) delta CO 6 min after drug injection was 71(37, 116)% in the ketamine group versus - 31(- 43, - 12)% in the fentanyl group, P value < 0.001. The CO, SV, HR, and MAP increased in the ketamine group and decreased in the fentanyl group in relation to the baseline reading; and all were higher in the ketamine group than the fentanyl group.

Conclusion: In patients with septic shock, ketamine bolus was associated with higher CO and SV compared to fentanyl bolus.

Clinical trial registration: Date of registration: 24/07/2023.

Clinicaltrials: gov Identifier: NCT05957302. URL: https://clinicaltrials.gov/study/NCT05957302 .

Keywords: Cardiac output; Fentanyl; Hypotension; Ketamine; Mechanical ventilation; Sedation; Septic shock.

Fig. 1

CONSORT’s flowchart

Fig. 2

Cardiac output. Markers are means and error bars are standard deviations. * denotes statistical significance between both groups, † denotes statistical significance compared to the baseline reading within the ketamine group, ‡ denotes statistical significance compared to the baseline reading within the fentanyl group

Fig. 3

Stroke volume. Markers are means and error bars are standard deviations. * denotes statistical significance between both groups, † denotes statistical significance compared to the baseline reading within the ketamine group, ‡ denotes statistical significance compared to the baseline reading within the fentanyl group

Fig. 4

RASS. Markers are means and error bars are standard deviations. † denotes statistical significance compared to the baseline reading within the ketamine group, ‡ denotes statistical significance compared to the baseline reading within the fentanyl group. RASS Richmond Agitation Sedation Scale