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Effect of sedative agent selection on morbidity, mortality and length of stay in patients with increase in intracranial pressure

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Brian G. Cornelius1, Elizabeth Webb2, Angela Cornelius2, Kenneth W.G. Smith3, Srdan Ristic3, Jay Jain3, Urska Cvek3, Marjan Trutschl3


1 Department of Anesthesia, University Health-Shreveport, Louisiana, Louisiana 71103, USA


2 Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA


3 Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University Shreveport, Louisiana 71115, USA


Corresponding Author: Brian G. Cornelius, Email: brian.cornelius@uhsystem.com


© 2018 World Journal of Emergency Medicine


DOI: 10.5847/wjem.j.1920–8642.2018.04.003


BACKGROUND: To identify the effects of sedative agent selection on morbidity, mortality, and length of stay in patients with suspected increase in intracranial pressure. Recent trends and developments have resulted in changes to medications that were previously utilized as pharmacological adjuncts in the sedation and intubation of patients with suspected increases in intracranial pressure. Medications that were previously considered contraindicated are now being used with increasing regularity without demonstrated safety and effectiveness. The primary objective of this study is to evaluate and compare the use of Ketamine as an induction agent for patients with increased intracranial pressure. The secondary objective was to evaluate and compare the use of Etomidate, Midazolam, and Ketamine in patients with increased intracranial pressure.

METHODS: We conducted a retrospective chart review of patients transported to our facility with evidence of intracranial hypertension that were intubated before trauma center arrival. Patients were identified during a 22-month period from January 2014 to October 2015. Goals were to evaluate the impact of sedative agent selection on morbidity, mortality, and length of stay.

RESULTS: During the review 148 patients were identified as meeting inclusion criteria, 52 were excluded due to incomplete data. Of those the patients primarily received; Etomidate, Ketamine, and Midazolam. Patients in the Ketamine group were found to have a lower mortality rate after injury stratification.

CONCLUSION: Patients with intracranial hypertension should not be excluded from receiving Ketamine during intubation out of concern for worsening outcomes.

(World J Emerg Med 2018;9(4):256–261)


KEY WORDS: Ketamine; Intracranial hypertension; Craniocerebral trauma; Head injury; Intubation

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