Citation Information :
Ketamine Use allows Noninvasive Ventilation in Distressed Patients with Acute Decompensated Heart Failure. Indian J Crit Care Med 2019; 23 (4):191-192.
Acute decompensated heart failure (ADHF) is responsible for a heavy clinical load on busy emergency departments (EDs) across the globe and especially in India. ADHF patients may present with severe respiratory distress, dyspnea, hypoxia, and high and low blood pressures. Managing the airway of such patients can at times be challenging. Nasal cannulae, face mask, and noninvasive positive pressure ventilation (NIPPV) are the cornerstones of providing oxygenation and ventilation to such patients while some extreme cases may require endotracheal intubation and mechanical ventilation.
An elderly female in severe respiratory distress and altered sensorium presented to our ED and had to be administered ketamine to facilitate proper NIPPV and avoid mechanical ventilation. She was weaned off the NIPPV in the ED itself over the next four hours. There are some case reports of using ketamine for NIPPV in asthma exacerbations, but none for the use in ADHF. Avoiding invasive mechanical ventilation via endotracheal intubation should be a constant goal and the last resort.
Seth S, Khanal S, et al. Epidemiology of acute decompensated heart failure in India: The AFAR Study (Acute failure study registry). J Pract Cardiovasc Sci 2015;1:35-38.
Gheorghiade M, Zannad F, et al. Acute heart failure syndromes: current state and framework for future research. Circulation 2005;112(25):3958-3968.
Fonarow GC, Abraham WT, et al. Influence of a performanceimprovement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med 2007;167(14):1493-1502.
Fonarow GC, Abraham WT, et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA 2007;297(1):61-70.
Vital FM, Ladeira MT, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2008;(5):CD005351.
Shlamovitz GZ, Hawthorne T. Intravenous ketamine in a dissociating dose as a temporizing measure to avoid mechanical ventilation in adult patient with severe asthma exacerbation. J Emerg Med 2011;41(5):492-494.
Weingart SD, Trueger S, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-355.
Page RL, O'Bryant CL, et al. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016;134(6): e32-69.
Mani R. Noninvasive ventilation for hypercapnic respiratory failure in COPD: encephalopathy and initial post-support deterioration of pH and PaCO2 may not predict failure. Indian J Crit Care Med 2005;9:217-224.
Green SM, Roback MG, et al. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med 2011;57(5):449-461.
