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

75 Scopus citations

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

ASJC Scopus subject areas

  • Emergency Medicine

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