Dexmedetomidine Versus Dexmedetomidine With Ketamine in Mechanically Ventilated ARDS Patients

Ketamine

Brief Summary

The goal of this clinical trial study is to compare dexmedetomidine versus the combination of dexmedetomidine with ketamine in hemodynamic changes and sedative effects in ARDS patients who are in need of mechanical ventilation. The main question\[s\] it aims to answer are: * \[question 1\]: Which dose that get the target in sedation, single and combined drugs? * \[question 2\]: In which drug group that hemodynamic did not affect Participants will be patients with ARDS that will be divided into two group the first ont will receive dexmedetomidine 0.5 µg/kg/h mixed with ketamine 0.5 mg/kg/h and the second one will receive dexmedetomidine at 0.5 µg/kg/h infusion only. In both the groups, studied drugs will be titrated to achieve target sedation.

Intervention / Treatment

  • dexmedetomidine plus ketamine (DRUG)
    titrating the dose of dexmedetomidine mixed with ketamine (staring dose 0.5ug/kg/hr, 0.5mg/kg/hr respectively)to achieve full sedation
  • Dexmedetomidine (DRUG)
    starting intravenous infusion with dexmedetomidine starting at dose 0.5ug/kg//hr and titrate the dose to achieve full sedation

Condition or Disease

  • Haemodynamic Instability

Phase

  • Phase 4

    • Study Design

    Study type: INTERVENTIONAL
    Status: Recruiting
    Study results: No Results Available
    Enrollment: 60 (ESTIMATED)
    Allocation: Randomized
    Primary Purpose: Prevention

    Masking

    SINGLE:
    • Participant

    Clinical Trial Dates

    Start date: Jun 01, 2023 ACTUAL
    Primary Completion: Jun 01, 2024 ESTIMATED
    Completion Date: Jun 01, 2024 ESTIMATED
    Study First Posted: Jul 19, 2023 ACTUAL
    Last Updated: Jul 27, 2023

    Sponsors / Collaborators

    Lead Sponsor: N/A
    Responsible Party: N/A

    This study will include 60 patients with ARDS who will be admitted to the intensive care unit (ICU) and chest ICU of Banha university hospitals during the period between June 2023 and June 2024.

    ARDS will be diagnosed based on the presence of new or worsening symptoms within one week of a known clinical insult; bilateral opacities on anteroposterior chest X-ray that are not due to effusions, nodules or lobar or lung collapse; and hypoxemia, defined as arterial oxygen tension/fraction of inspired oxygen (Pao2/FiO2) \< 300 mm Hg and a minimum positive end-expiratory pressure ≥ 5 cm H2O, that is not explained by heart failure or fluid overload.

    Patients were divided randomly into two groups. Group A (n = 30); received with starting dose of dexmedetomidine 0.5 µg/kg/h mixed with ketamine 0.5 mg/kg/h and Group B (n = 30); received dexmedetomidine at 0.5 µg/kg/h infusion only. In both the groups, studied drugs will be titrated to achieve target sedation.

    All patients will be subjected to the following:

    1. Thorough history taking and clinical examination
    2. Calculation of acute physiology and chronic health evaluation (APACHE) score at time of ICU admission
    3. Sedation score calculation using the Richmond Agitation-Sedation Scale (RASS)
    4. ECG, blood pressure monitoring
    5. Measurement of plasma C-reactive protein (CRP) level before and after initiation of sedation.
    6. Measurement of oxygenation status (Pao2/Fio2) before and at 24, 48, 72, and 120 h after the administration of the sedatives
    7. Any adverse effects related to sedation or intubation will be recoded

    All data will be tabulated and statistically analyzed

    Participant Groups

    • starting intravenous infusion dose of dexmedetomidine 0.5 µg/kg/h mixed with ketamine 0.5 mg/kg/h to 30 mechanically ventilated ARDS patient

    • dexmedetomidine at 0.5 µg/kg/h intravenous infusion only to be titrated to achieve full sedation to 30 mechanically ventilated ARDS patient

    Eligibility Criteria

    Sex: All
    Minimum Age: 18
    Age Groups: Adult / Older Adult
    Healthy Volunteers: Yes

    Inclusion Criteria:

    * patients with ARDS with the following:

    * Those whose duration of endotracheal intubation was \> 120 h
    * those whose ages were 18- 70 years old
    * those with acute physiology and chronic health evaluation (APACHE) II scores \> 12 points.

    Exclusion Criteria:

    * patients with a history of allergy to ketamine or dexmedetomidine
    * Pregnant women,
    * patients in the early stage of recovery,
    * patients with unstable hemodynamics, bradycardia, sinus arrest, or other cardiac arrhythmias

    This clinical trial is recruiting

    Are you interested in participating in this trial or others? We'd love to help.

    Primary Outcomes

    • change of PaO2/FiO2

    • change of PEEP parameter that need to maintain oxygen saturation above 88%

    Secondary Outcomes

    • change of serum level of CRP (mg/dl)

    More Details

    NCT Number: NCT05951387
    Other IDs: RC 37-5-2023
    Study URL: https://clinicaltrials.gov/study/NCT05951387
    Last updated: Sep 29, 2023