(1029) Effect of Propofol Versus Ketamine for Post-Intubation Sedation on Hemodynamics in Trauma Patients

Introduction: Ketamine is often selected for post intubation sedation due to its hemodynamic neutrality, however there is risk for hypotension in patients that are catecholamine depleted, such as trauma patients with a high shock index. Our objective was to compare rates of post intubation hypotension among trauma patients receiving ketamine versus propofol for post intubation sedation.

Methods: Retrospective cohort study of adult trauma patients intubated in the emergency department (ED) at a level 1 trauma center who received ketamine or propofol as post intubation sedation. Those with traumatic brain or spinal injury were excluded. Mechanism of injury, age, Glasgow Coma Scale (GCS) and hemodynamics were recorded. The primary outcome was post intubation hypotension defined as systolic blood pressure (SBP) < 100 mmHg, mean arterial pressure (MAP) < 60 mmHg, massive transfusion, initiation of vasopressors, or increasing vasopressor requirements while in the ED. Secondary outcomes included mortality, duration of ventilation and hospital length of stay.

Results: 104 patients were included; 25 received ketamine and 79 received propofol. There were no differences in baseline demographics or GCS between the groups. The median age was 58 years with 64% being male and 84% of white race. Most common trauma type was blunt injury (88%) followed by penetrating injury (8%). Patients receiving ketamine had lower baseline SBP and MAP compared to those given propofol; median SBP 109 mmHg (IQR 100, 137) with ketamine vs 134 mmHg (109, 150) with propofol (p=0.005); median MAP was 80 mmHg (69, 100) with ketamine and 95 mmHg (80, 113) with propofol (p=0.01). Hypotension was seen in 96% of patients receiving ketamine and 88.6% of patients receiving propofol (OR 3.08, 95% CI 0.37-25.62, p=0.30). There was no difference in mortality (16% ketamine vs 21.5% propofol, OR 0.70, 95% CI 0.21-2.30, p=0.55). Patients who received ketamine had a longer median (IQR) ICU length of stay 5 (4, 9) vs 3 (2, 7) days (p=0.01) but similar duration of ventilation 3 (2, 5) vs 2 (2, 5) days (p=0.20) compared to propofol.

Conclusions: Post intubation hypotension was very common (90%) among this cohort of trauma patients. There was no significant difference between those who received ketamine versus propofol for post intubation sedation in the ED.