The Combination of Ketamine and Dexmedetomidine for Sedation During Non-Invasive Ventilation in Acute Respiratory Failure

Abstract

The importance of weaning (burden) is emphasized in critical cases. Recent studies have focused on the importance of weaning in critical situations, especially in agitated patients and the elderly who do not cooperate with noninvasive ventilation or CPAP, which requires the use of alternative, less common techniques to achieve adequate weaning.

In the context of weaning, Propofol and midazolam (both GABA receptor agonists) and ketamine (an NMDA receptor antagonist with multiple actions) are among the most commonly used options.

In recent years, dexmedetomidine, a central alpha-2 agonist with a high safety profile, has increased in use. However, its results when used alone for weaning are variable due to its lack of analgesic action, slow onset, and the potential to cause hemodynamic effects such as bradycardia and hypotension, especially when used at high doses.

Unlike GABA agonists, dexmedetomidine can wean patients who are on ventilation without causing respiratory depression. It also promotes natural sleep through a direct effect on the locus coeruleus, reducing the risk of postoperative delirium after weaning. However, a major drawback of this drug is its high cost compared with other medications.