Pharmacokinetics of Ketamine at Dissociative Doses in an Adult Patient With Refractory Status Asthmaticus Receiving Extracorporeal Membrane Oxygenation Therapy.

Authors

Edwin Lam, Thomas Jefferson UniversityFollow
Ankit K. Rochani, Thomas Jefferson UniversityFollow
Gagan Kaushal, Thomas Jefferson UniversityFollow
Brandi N. Thoma, Thomas Jefferson UniversityFollow
Julian Tanjuakio, Thomas Jefferson UniversityFollow
Frances Mae West, Thomas Jefferson UniversityFollow
Hitoshi Hirose, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

3-28-2019

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Clinical Therapeutics, March 2019.

The published version is available at https://doi.org/10.1016/j.clinthera.2019.03.005. Copyright © Lam et al.

Abstract

PURPOSE: First-line management of severe asthma exacerbations include the use of inhaled short-acting β-agonists, anticholinergics, and systemic corticosteroids. Continuous intravenous ketamine given at dissociative doses may be a pharmacologic option in patients who are intubated with life-threatening severe bronchospasm unresponsive to standard therapy. We describe the case of a 44-year-old man admitted to the intensive care unit for status asthmaticus requiring intubation and mechanical ventilation.

METHODS: The patient developed severe refractory hypercapnic respiratory failure necessitating additional respiratory support with veno-venous extracorporeal membrane oxygenation (ECMO) therapy. Ketamine treatment was initiated at 0.5 mg/kg/h continuous infusion on the day of admission for pain control and required up-titration to 2 mg/kg/h by intensive care unit day 4 for bronchodilation. Whole blood samples were obtained for pharmacokinetic analysis of ketamine during ECMO.

FINDINGS: The plasma concentration at steady state was 1018.7 ng/mL, with an estimated clearance of 1.96 L/kg/h after up-titration. The V_d was 14.18 L/kg, the k_e was 0.14 hr^-1, and the t_½ was 5 hours.

IMPLICATIONS: Compared with healthy adults, there was a 6.5-fold increase in the V_d. However, the V_d was similar compared with critically ill patients not receiving ECMO. Further studies should focus on the effect of ECMO on ketamine pharmacokinetic properties.

Recommended Citation

Lam, Edwin; Rochani, Ankit K.; Kaushal, Gagan; Thoma, Brandi N.; Tanjuakio, Julian; West, Frances Mae; and Hirose, Hitoshi, "Pharmacokinetics of Ketamine at Dissociative Doses in an Adult Patient With Refractory Status Asthmaticus Receiving Extracorporeal Membrane Oxygenation Therapy." (2019). Department of Pharmacology and Experimental Therapeutics Faculty Papers. Paper 104.
https://jdc.jefferson.edu/petfp/104

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

30929859

Language

English