Therapeutic Effect of Ketamine Nebulization in Acute Respiratory Distress Syndrome: A Randomized Controlled Trial

Introduction: Acute Respiratory Distress Syndrome (ARDS) results in severe hypoxemia and decreased lung compliance due to alveolar–capillary damage, often requiring mechanical ventilation. Ketamine has bronchodilatory and anti-inflammatory properties, suggesting a potential therapeutic role in ARDS. This study evaluated the clinical effects of nebulized ketamine in ventilated ARDS patients. Methods: A randomized, double-blind controlled trial was conducted on 40 mechanically ventilated adults with ARDS, divided into two equal groups. Group K received nebulized ketamine (0.75 mg/kg) three times daily, whereas Group C served as control. Daily Sequential Organ Failure Assessment (SOFA) scores and P/F ratios were recorded, and Murray scores and Interleukin 6 (IL-6) levels were measured on Days 1, 3, and 5. Additional outcomes included 28-day mortality and sedative and vasopressor requirements. Results: Group K demonstrated significant improvement in P/F ratio on Days 2 and 3. Murray scores improved earlier and remained superior in Group K from 24 h through Day 5. SOFA scores showed a significant reduction from Day 3 onward, accompanied by decreased IL-6 levels on Days 3 and 5. No major adverse effects were noted, and mortality and hemodynamic support needs were comparable between groups. Conclusion: Nebulized ketamine appears to be a safe and beneficial adjunct in ARDS management, improving oxygenation and reducing inflammatory response. Larger, multicenter trials with extended follow-up are needed to validate these findings and determine the optimal administration strategy.