Low Dose Ketamine for Blunt Thoracic Trauma

Study Design: Randomized controlled double-blinded trial: Patients will then be randomized into one of two study groups. Both groups will receive a normal saline infusion for 48 hours of therapy. The treatment group will have ketamine added to their saline infusion via blinded pharmacy protocol to receive continuous infusion of ketamine at 0.1mg/kg/hour. The control group will receive only normal saline. Administration will occur via piggyback infusion in accordance with nursing policy.

Setting/Participants:

• North Memorial Health Hospital: patients on 5-South - Trauma Neuro Intensive Care Unit (TNICU) and 6-West - Trauma Floor
• 50 people will take part in this study. 25 study subjects will receive an infusion of ketamine and 25 will receive a saline infusion.
• Patients 18 years of age or older with 3 or more rib fractures admitted to North Memorial Health Hospital will be considered for the study.

Study Interventions and Measures:

• Ketamine low-dose infusion administered at 0.1 mg/kg/hr for 48 hours as an adjunct to standardized rib fracture management interventions as outlined in facility-approved Guidelines for Rib Fracture Management.
• The primary study outcome will be amount of narcotic used over the 48-hour study period (expressed as morphine mg equivalents).
• Secondary outcome measures will include: need for endotracheal intubation or non-invasive positive pressure ventilation, oxygen requirements, daily incentive spirometer values, daily forced vital capacity measurements, and subjective patient pain ratings.
• Other outcomes measured will be Intensive Care Unit stay, total hospital length of stay, and adverse medication effects.

Inclusion criteria

• Males or females 18 years of age or older
• Diagnosis of 3 or more acute rib fractures related to blunt traumatic chest injury.
• Able to undergo consent procedure and give valid consent, or availability of family member to provide consent for the study

Exclusion criteria

• Age <18 years
• Cognitively impaired
• Pregnant or lactating females.
• Glasgow Coma Score (GCS) of ≤ 14 at time of admission
• Evidence of increased intraocular pressure
• Presence of acute coronary syndrome
• Diagnosed moderate to severe traumatic brain injury
• Evidence of uncontrolled intracranial hypertension
• History of seizures or stroke
• History of severe psychiatric disorders
• Allergy to ketamine
• Currently being treated, prior to admission, with opiate agonist/antagonist therapy
• Presence of poorly controlled hypertension, cardiac arrhythmias, and/or tachycardia on admission
• Subjects who, in the opinion of the Investigator, may be inappropriate for study participation.