(1436) Effect of Ketamine vs Propofol on Hemodynamics of Septic Patients Intubated in Emergency Department

Introduction: Patients presenting to the emergency department (ED) with sepsis requiring intubation are at high risk of morbidity from hypotension, shock, and hemodynamic collapse. Sedative choice can worsen hypotension, and intravenous (IV) ketamine is often chosen post intubation for its proposed neutral effect. However, catecholamine depletion might also cause hypotension when administering ketamine. The objective of this study is to compare the incidence of hypotension post intubation in patients receiving ketamine vs propofol.

Methods: This is a retrospective cohort study of adult patients with sepsis, intubated in the ED at a tertiary medical center from 2018-2022. Patients were included if they received IV ketamine or propofol as their primary sedative agent post intubation. The primary outcome was hypotension defined as a decrease in mean arterial pressure (MAP) > 10 mmHg, or MAP < 60 mmHg, or initiation of vasopressors after initiation of sedation. Secondary outcomes assessed were utilization of adjunct sedation, and hospital lengths of stay.

Results: 96 patients met inclusion criteria with 28 receiving ketamine and 68 receiving propofol. Patients had similar baseline characteristics. 63.5% of patients were male and 72.9% white with median age of 67 years. Initial median lactate was 2.8. Patients in the ketamine group had lower baseline median systolic blood pressure (SBP), 105 (91,117) vs 122 (99, 148) (p=0.012) and lower MAP, 74 (63, 89) vs 95 (73, 109) (p=0.003) compared to propofol. Hypotension occurred in 92.9% of patients in the ketamine group vs 82.4% in the propofol group (p=0.19). More patients in the propofol group received additional sedatives within 30 minutes (ketamine: 35.7% vs propofol: 70.6%, p=0.01; OR 0.51, 95%CI 0.23-1.14). Median SOFA score at 24 hours was higher in patients who received ketamine 12 (10, 15) vs 9 (6, 12) (p=0.003). ICU and hospital lengths of stay were similar between the two groups.

Conclusions: There was a high incidence of post intubation hypotension observed in this cohort, with no difference in the rates of hypotension in patients who received ketamine versus those who received propofol despite the lower baseline BP among those that received ketamine.