Background Optimization of induction drug selection is one of the key steps to preserve circulatory stability during tracheal intubation. This study aims to evaluate the effect of using full dose ketamine on postintubation venous blood gases and lactate levels as early indicators of possible improvement in tissue perfusion in shocked patients intubated in the emergency department. Patients and methods This randomized controlled trial, conducted at Alexandria Main University Hospital involved 80 shocked patients requiring emergency tracheal intubation. Patients were categorized into two groups. The control group (C group) underwent intubation using ketamine (0.75 mg/kg) combined with midazolam (0.05 mg/kg) as induction agents. The intervention group (N group) intubated using a higher ketamine dose (1–2 mg/kg). Baseline venous blood gases and lactate levels were compared to those 30 min postsuccessful tracheal intubation. Results In the C group, follow up venous blood gases sample withdrawn 30 min after endotracheal intubation demonstrated an elevation of mean blood pH by 0.05±0.10 relative to 0.04±0.11 in the N group. This difference was of no statistical significance (P=0.773). In the C group, follow up venous blood gases sample withdrawn 30 min after endotracheal intubation demonstrated an elevation of mean blood bicarbonate level by 1.89±3.15 relative to 1.67±3.88 in new protocol group. This difference was of no statistical significance (P=0.682). In the C group, follow up lactate levels withdrawn 30 min after endotracheal intubation demonstrated a drop in mean blood lactate level by 0.54±2.14 mmol/l relative to 1.18±2.33 mmol/l in the N group. This difference was of no statistical significance (P=0.056).
Elkfafy et al. (Thu,) studied this question.