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Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study
Author(s) -
Parsch Cathrin S,
Boonstra Adrianne,
Teubner David,
Emmerton Wade,
McKenny Brian,
Ellis Daniel Y
Publication year - 2017
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12763
Subject(s) - medicine , ketamine , guideline , odds ratio , sedation , intubation , confidence interval , emergency medicine , retrospective cohort study , mental health , incidence (geometry) , anesthesia , psychiatry , physics , pathology , optics
Objectives The aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline. Methods This is a a retrospective cohort study of mental health patients with acute behavioural disturbance, transported between January 2010 and December 2015. Results A total of 78 patients were transported in the study period, 50 before and 28 after implementation of the ketamine guideline in June 2013. The introduction of the ketamine guideline was associated with a significant reduction in intubation for transport (36.00 vs 7.14%) (odds ratio 0.14, 95% confidence interval 0.02–0.71, P < 0.01). The likelihood of utilising ketamine for non‐intubated patients ( n = 58) was higher in the period after implementation (37.50 vs 84.62%, odds ratio 9.17, 95% confidence interval 2.54–33.08, P < 0.005). The incidence of complications in our series was low. Conclusions The implementation of a ketamine clinical practice guideline for agitated mental health patients was associated with an increase in the number of patients receiving ketamine as part of their sedation regime and a reduction in the number of patients requiring intubation for transport. Appropriately trained critical care retrieval teams should consider ketamine as part of the sedation regime for agitated mental health patients.