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Original research
Association between traumatic brain injuries and ketamine infusion side effects following combat injury
  1. Alexandra Victoria Kane1,2,
  2. N A Giordano3,
  3. J Tran1,2,
  4. M L Kent4 and
  5. K B Highland1,2
  1. 1 Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA
  2. 2 Defense and Veterans Center for Integrative Pain Management, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
  3. 3 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
  4. 4 Department of Anesthesiology, Duke University, Durham, North Carolina, USA
  1. Correspondence to Alexandra Victoria Kane, Defense and Veterans Center for Integrative Pain Management, Department of Anesthesia, Uniformed Services University, Bethesda MD 20852, Maryland, USA; akane{at}dvcipm.org

Abstract

Introduction Ketamine is a vital component for acute pain management in emergency trauma care for both civilian and military hospitals. This preliminary analysis examined whether combat-injured US service members sustaining traumatic brain injuries (TBI) experienced increased odds of ketamine side effects compared with those without TBI.

Methods This preliminary analysis included combat-injured service members, ages ≥18 years with documented pain scores during the 24 hours before and 48 hours after receiving an intravenous ketamine infusion at Walter Reed National Military Medical Center (WRNMMC) between 2007 and 2014. Logistic regression modeling examined the association between TBI and ketamine side effects (eg, hallucinations, nightmares, dysphoria, nausea, decreased oxygen saturation) during hospitalisation.

Results Of the 77 patients, 62% presented with a documented TBI. Side effects were documented for 18.8% of those without TBI and 24.4% of those with TBI. Analyses were unable to find evidence against the null hypothesis with the current sample size, even when adjusting for injury characteristics and preinfusion opioid doses (adjusted OR=0.90 (95% CI 0.26 to 3.34), p=0.87).

Conclusion In this small sample of combat-injured service members, we were unable to detect a difference in ketamine-related side effects by documented TBI status. These hypothesis-generating findings support the need for future studies to examine the use of intravenous ketamine infusions for pain management, and subsequent care outcomes in patients who experience polytraumatic trauma inclusive of TBI.

  • pain management
  • adult intensive & critical care
  • orthopaedic & trauma surgery

Data availability statement

Data were collected from retrospective reviews of the Department of Defense’s electronic health records. Data use is subject to the permissions and guidance of the Department of Defense.

https://doi.org/10.1136/bmjmilitary-2020-001443

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    Data availability statement

    Data were collected from retrospective reviews of the Department of Defense’s electronic health records. Data use is subject to the permissions and guidance of the Department of Defense.

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    Footnotes

    • Twitter @nagiordano

    • Contributors All authors were involved in the study design, data analysis and revision of the manuscript. All authors contributed, read and approved the final manuscript.

    • Funding Funding for this project was provided by the Uniformed Services University through Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. under Cooperative Agreement #HU00011920042.

    • Disclaimer The views expressed in this abstract are those of the authors and do not reflect the official policy of the Uniformed Services University, the Department of the Army, Department of Defense, the United States Government, or The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.