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- 저자 : ( Seiji Koike ) (검색결과 1 건)
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( Austin J. Peters ),( Saad A. Khan ),( Seiji Koike ),( Susan Rowell ),( Martin Schreiber ) 대한외상학회 2023 大韓外傷學會誌 Vol.36 No.4
Purpose: Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the fa vorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ket amine administered in subjects with TBI is associated with patient survival or disability. Methods: We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ket amine-unexposed TBI subjects to determine whether an association exists between ketamine ad ministration and mortality, as well as secondary outcome measures. Results: We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be in tubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no differ ence in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-ex posed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations. Conclusions: Ketamine administration was not associated with worse survival or disability despite be ing administered to more severely injured subjects. Ketamine exposure was associated with reduced el evations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.
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