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NCT Number: NCT05957302

Hemodynamic Effects of Bolus of Ketamine Versus Fentanyl in Patients With Septic Shock

Ketamine is a commonly used drug for sedation and induction of anesthesia in patients with shock and/or cardiac dysfunction. Ketamine is characterized by its cardiovascular stimulatory effect due to increase release of endogenous catecholamines. On the other hand, laboratory data on the isolated human myofibers suggest that ketamine had a direct myocardial depressive effect; accordingly, many experts believe that ketamine might have a negative hemodynamic effect in catecholamine depleted patients such as critically ill patients. In critically ill patients, there are contradicting results for the effect of ketamine on the hemodynamic profile and there is paucity of clinical data about the effect of ketamine on cardiac contractility and cardiac output (CO). Cardiac output is the primary determinant of global oxygen delivery to organs and maintaining stable CO in critically ill patients is at most importance to avoid further organ damage in such patients.

Therefore, this study is designed to evaluate the effect a single bolus of ketamine on CO in patients with septic shock in comparison to fentanyl bolus.

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Key information

Conditions

Ketamine Fentanyl Infections Inflammation Pathologic Processes Pathological Conditions, Signs and Symptoms Sepsis Septic Shock Shock Shock, Septic Systemic Inflammatory Response Syndrome

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Ahmed Mohamed Hasanin

Cairo, 11432, Egypt

About this study

Patients meeting the inclusion criteria will receive the study drug according to the randomization, if a bolus of sedation is required for resuming sedation after sedation vacation. All patients will be monitored by 5-lead electrocardiogram, pulse oximetry, and noninvasive blood pressure.

Hypotension defined as mean arterial pressure < 65 mmHg and will be managed by increasing the norepinephrine infusion rate by 20%.

Bedside echocardiography will be used to measure the cardiac output by an experienced physician who is not aware of the nature of the study drug. The left ventricular outflow diameter (LVOT) will be measured in the parasternal long-axis view. Then velocity time integral (VTI) will be measured from the apical five-chamber view. The average of three VTI readings will be calculated.

The cardiac output will be calculated by the equation:

CO = π X (LVOT diameter/2) X VTI X heart rate Delta CO% will be calculated as percentage of change at each time point in relation to the baseline measurement the CO, heart rate, mean blood pressure will be measured before drug administration and at 3, 6, 10 and 15 min after drug administration

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adult (>18 years) patients.
  • With septic shock on vasopressor therapy
  • Mechanically ventilated
  • Need for sedation

Exclusion criteria

  • Hemodynamic instability (MAP <65 mmHg) despite appropriate volume replacement and vasopressor therapy
  • Noradrenaline infusion rate <0.05 mcg/kg/min
  • Poor cardiac window on the ultrasound.
  • Known allergy to study drugs
  • Neurocritical patients with signs of increased intracranial tension

Treatment and study plan

ketamine

Drug

100 mg of ketamine diluted in 10 mL saline (10 mg /mL) and patient will receive 0.1 mL/kg

Fentanyl

Drug

100 mcg of fentanyl diluted in 10 mL saline (10 mcg /mL) and patient will receive 0.1 mL/kg

Primary outcomes

  1. 6-minutes Delta CO%

    Time frame: at 6 minutes after drug administration

    percentage of change at 6 min after drug administration in relation to the baseline measurement

Secondary outcomes

  1. Delta CO%

    Time frame: 3, 6, 10 and 15 minutes after drug administration

    percentage of change at each time point after drug administration in relation to the baseline measurement

  2. heart rate

    Time frame: 3, 6, 10 and 15 minutes after drug administration

    beat per minute

  3. mean blood pressure

    Time frame: 3, 6, 10 and 15 minutes after drug administration

    mmHg

  4. norepinephrine dose

    Time frame: 3, 6, 10 and 15 minutes after drug administration

    mcg/kg/min

Sponsors and collaborators

Lead sponsor

Cairo University

Other

Registry information

Official study title

Comparing the Hemodynamic Effects of Bolus of Ketamine and Fentanyl in Patients With Septic Shock: a Randomized Controlled Trial

Important dates

Study start
2023
Primary completion
2023
Study completion
2023
First posted
Jul 24, 2023
Registry last updated
Dec 22, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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