Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma

J. C. Howton, John S Rose, S. Duffy, T. Zoltanski, M. A. Levitt

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Study objective: To evaluate the efficacy of IV ketamine in the management of acute, severe asthma. Methods: This prospective, randomized, double- blind, placebo-controlled clinical trial at an urban teaching hospital emergency department involved 83 consecutive patients aged 18 to 85 with a clinical diagnosis of acute asthmatic exacerbation and a peak expiratory flow of less than 40% of the predicted value after three albuterol nebulizer treatments. All patients received oxygen, continuous nebulized albuterol, and methylprednisolone sodium succinate (Solu-Medrol). Patients then received either ketamine hydrochloride in a bolus of 2 mg/kg followed by IV infusion of .5 mg/kg per hour for 3 hours or a placebo bolus and infusion for 3 hours. Because of the occurrence of dysphoric reactions, the bolus dose was lowered to 1 mg/kg after the first 9 patients; the infusion dose was kept the same. Results: The first nine patients were eliminated from analysis. Repeated ANOVA testing on the remaining 44 patients determined significant improvements over time within each treatment group in peak flow (F=3.637, P=.004), Borg score (F=22.959, P=.0001), respiratory rate (F=8.11, P=.0001), and 1-second forced expiratory volume (F=9.078, P=.0001). However, no difference could be detected over time between treatment groups (power, 80%). Patients receiving ketamine gave the treatment a rating of 43 on a scale of 1 to 5, whereas those receiving placebo scored their treatment 3.7 (P=.0285). The hospital admission rate was not different between treatment groups (P=.1088). Conclusion: IV ketamine at a dose low enough to avoid dysphoric reactions demonstrated no increased bronchodilatory effect compared with standard therapy in treating exacerbations of asthma in the ED. Although there was a slight increase in satisfaction in the ketamine group, no clinical benefit in terms of hospital admission rate was noted ketamine in acute asthma.

Original languageEnglish (US)
Pages (from-to)170-175
Number of pages6
JournalAnnals of Emergency Medicine
Volume27
Issue number2
StatePublished - 1996
Externally publishedYes

Fingerprint

Ketamine
Asthma
Placebos
Methylprednisolone Hemisuccinate
Albuterol
Therapeutics
Nebulizers and Vaporizers
Urban Hospitals
Hospital Departments
Controlled Clinical Trials
Forced Expiratory Volume
Respiratory Rate
Teaching Hospitals
Hospital Emergency Service
Analysis of Variance
Oxygen

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. / Howton, J. C.; Rose, John S; Duffy, S.; Zoltanski, T.; Levitt, M. A.

In: Annals of Emergency Medicine, Vol. 27, No. 2, 1996, p. 170-175.

Research output: Contribution to journalArticle

Howton, JC, Rose, JS, Duffy, S, Zoltanski, T & Levitt, MA 1996, 'Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma', Annals of Emergency Medicine, vol. 27, no. 2, pp. 170-175.
Howton, J. C. ; Rose, John S ; Duffy, S. ; Zoltanski, T. ; Levitt, M. A. / Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. In: Annals of Emergency Medicine. 1996 ; Vol. 27, No. 2. pp. 170-175.
@article{190c2b2578444979ad4ba0970d83be22,
title = "Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma",
abstract = "Study objective: To evaluate the efficacy of IV ketamine in the management of acute, severe asthma. Methods: This prospective, randomized, double- blind, placebo-controlled clinical trial at an urban teaching hospital emergency department involved 83 consecutive patients aged 18 to 85 with a clinical diagnosis of acute asthmatic exacerbation and a peak expiratory flow of less than 40{\%} of the predicted value after three albuterol nebulizer treatments. All patients received oxygen, continuous nebulized albuterol, and methylprednisolone sodium succinate (Solu-Medrol). Patients then received either ketamine hydrochloride in a bolus of 2 mg/kg followed by IV infusion of .5 mg/kg per hour for 3 hours or a placebo bolus and infusion for 3 hours. Because of the occurrence of dysphoric reactions, the bolus dose was lowered to 1 mg/kg after the first 9 patients; the infusion dose was kept the same. Results: The first nine patients were eliminated from analysis. Repeated ANOVA testing on the remaining 44 patients determined significant improvements over time within each treatment group in peak flow (F=3.637, P=.004), Borg score (F=22.959, P=.0001), respiratory rate (F=8.11, P=.0001), and 1-second forced expiratory volume (F=9.078, P=.0001). However, no difference could be detected over time between treatment groups (power, 80{\%}). Patients receiving ketamine gave the treatment a rating of 43 on a scale of 1 to 5, whereas those receiving placebo scored their treatment 3.7 (P=.0285). The hospital admission rate was not different between treatment groups (P=.1088). Conclusion: IV ketamine at a dose low enough to avoid dysphoric reactions demonstrated no increased bronchodilatory effect compared with standard therapy in treating exacerbations of asthma in the ED. Although there was a slight increase in satisfaction in the ketamine group, no clinical benefit in terms of hospital admission rate was noted ketamine in acute asthma.",
author = "Howton, {J. C.} and Rose, {John S} and S. Duffy and T. Zoltanski and Levitt, {M. A.}",
year = "1996",
language = "English (US)",
volume = "27",
pages = "170--175",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma

AU - Howton, J. C.

AU - Rose, John S

AU - Duffy, S.

AU - Zoltanski, T.

AU - Levitt, M. A.

PY - 1996

Y1 - 1996

N2 - Study objective: To evaluate the efficacy of IV ketamine in the management of acute, severe asthma. Methods: This prospective, randomized, double- blind, placebo-controlled clinical trial at an urban teaching hospital emergency department involved 83 consecutive patients aged 18 to 85 with a clinical diagnosis of acute asthmatic exacerbation and a peak expiratory flow of less than 40% of the predicted value after three albuterol nebulizer treatments. All patients received oxygen, continuous nebulized albuterol, and methylprednisolone sodium succinate (Solu-Medrol). Patients then received either ketamine hydrochloride in a bolus of 2 mg/kg followed by IV infusion of .5 mg/kg per hour for 3 hours or a placebo bolus and infusion for 3 hours. Because of the occurrence of dysphoric reactions, the bolus dose was lowered to 1 mg/kg after the first 9 patients; the infusion dose was kept the same. Results: The first nine patients were eliminated from analysis. Repeated ANOVA testing on the remaining 44 patients determined significant improvements over time within each treatment group in peak flow (F=3.637, P=.004), Borg score (F=22.959, P=.0001), respiratory rate (F=8.11, P=.0001), and 1-second forced expiratory volume (F=9.078, P=.0001). However, no difference could be detected over time between treatment groups (power, 80%). Patients receiving ketamine gave the treatment a rating of 43 on a scale of 1 to 5, whereas those receiving placebo scored their treatment 3.7 (P=.0285). The hospital admission rate was not different between treatment groups (P=.1088). Conclusion: IV ketamine at a dose low enough to avoid dysphoric reactions demonstrated no increased bronchodilatory effect compared with standard therapy in treating exacerbations of asthma in the ED. Although there was a slight increase in satisfaction in the ketamine group, no clinical benefit in terms of hospital admission rate was noted ketamine in acute asthma.

AB - Study objective: To evaluate the efficacy of IV ketamine in the management of acute, severe asthma. Methods: This prospective, randomized, double- blind, placebo-controlled clinical trial at an urban teaching hospital emergency department involved 83 consecutive patients aged 18 to 85 with a clinical diagnosis of acute asthmatic exacerbation and a peak expiratory flow of less than 40% of the predicted value after three albuterol nebulizer treatments. All patients received oxygen, continuous nebulized albuterol, and methylprednisolone sodium succinate (Solu-Medrol). Patients then received either ketamine hydrochloride in a bolus of 2 mg/kg followed by IV infusion of .5 mg/kg per hour for 3 hours or a placebo bolus and infusion for 3 hours. Because of the occurrence of dysphoric reactions, the bolus dose was lowered to 1 mg/kg after the first 9 patients; the infusion dose was kept the same. Results: The first nine patients were eliminated from analysis. Repeated ANOVA testing on the remaining 44 patients determined significant improvements over time within each treatment group in peak flow (F=3.637, P=.004), Borg score (F=22.959, P=.0001), respiratory rate (F=8.11, P=.0001), and 1-second forced expiratory volume (F=9.078, P=.0001). However, no difference could be detected over time between treatment groups (power, 80%). Patients receiving ketamine gave the treatment a rating of 43 on a scale of 1 to 5, whereas those receiving placebo scored their treatment 3.7 (P=.0285). The hospital admission rate was not different between treatment groups (P=.1088). Conclusion: IV ketamine at a dose low enough to avoid dysphoric reactions demonstrated no increased bronchodilatory effect compared with standard therapy in treating exacerbations of asthma in the ED. Although there was a slight increase in satisfaction in the ketamine group, no clinical benefit in terms of hospital admission rate was noted ketamine in acute asthma.

UR - http://www.scopus.com/inward/record.url?scp=0030039890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030039890&partnerID=8YFLogxK

M3 - Article

C2 - 8629747

AN - SCOPUS:0030039890

VL - 27

SP - 170

EP - 175

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 2

ER -