Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies

Purpose Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and syste...

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Bibliographic Details
Published in:European journal of clinical pharmacology 2022-10, Vol.78 (10), p.1613-1622
Main Authors: La Via, Luigi, Sanfilippo, Filippo, Cuttone, Giuseppe, Dezio, Veronica, Falcone, Monica, Brancati, Serena, Crimi, Claudia, Astuto, Marinella
Format: Article
Language:English
Subjects:
Age composition
Anticholinergics
Asthma
Biomedical and Life Sciences
Biomedicine
Bronchospasm
Clinical trials
Corticosteroids
Emergency medical care
Fentanyl
Ketamine
Mechanical ventilation
Oxygenation
Patients
Pediatrics
Pharmacology/Toxicology
Review
Systematic review
Weaning
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Summary:Purpose Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and systemic corticosteroids), another pharmacological option is represented by ketamine. We performed a systematic review to explore the role of ketamine in refractory SAEs. Methods We performed a systematic search on PubMed and EMBASE up to August 12th, 2021. We selected prospective studies only, and outcomes of interest were oxygenation/respiratory parameters, clinical status, need for invasive ventilation and effects on weaning. Results We included a total of seven studies, five being randomized controlled trials (RCTs, population range 44–92 patients). The two small prospective studies (n = 10 and n = 11) did not have a control group. Four studies focused on adults, and three enrolled a pediatric population. We found a large heterogeneity regarding sample size, age and gender distribution, inclusion criteria (different severity scores, if any) and ketamine dosing (bolus and/or continuous infusion). Of the five RCTs, three compared ketamine to placebo, while one used fentanyl and the other aminophylline. The outcomes evaluated by the included studies were highly variable. Despite paucity of data and large heterogeneity, an overview of the included studies suggests absence of clear benefit produced by ketamine in patients with refractory SAE, and some signals towards side effects. Conclusion Our systematic review does not support the use of ketamine in refractory SAE. A limited number of prospective studies with large heterogeneity was found. Well-designed multicenter RCTs are desirable.
ISSN:0031-6970
1432-1041
DOI:10.1007/s00228-022-03374-3