This single-center, prospective, randomized, controlled pilot study compared the hemodynamic effects and prognosis of esketamine versus remifentanil, both used in combination with propofol, for sedation and analgesia in patients with septic shock receiving invasive mechanical ventilation in the ICU.

A total of 120 patients were randomized, 60 to each group (esketamine+propofol or remifentanil+propofol), targeting CPOT <3 and RASS -2~0. The primary outcome was the dosage of norepinephrine. Secondary outcomes included mechanical ventilation time, propofol dosage, intestinal dysfunction rate, ICU and hospital length of stay, hospital mortality, and 28-day survival rate. The results showed that the esketamine group required a significantly lower median dosage of norepinephrine (1.72 mg/kg) compared to the remifentanil group (4.09 mg/kg, P=0.007). However, there were no significant differences between the two groups in adverse event rate, intestinal dysfunction rate, dosage of propofol, mechanical ventilation time, ICU length of stay, hospital length of stay, hospital mortality, or 28-day survival rate (all P>0.05). The Kaplan-Meier survival analysis for 28-day survival also showed no significant difference (P=0.225).

The study concluded that esketamine may decrease the dosage of norepinephrine in septic shock patients on mechanical ventilation, suggesting a potential benefit in stabilizing hemodynamics. It appeared to be an effective and safe agent for this patient population based on the evaluated outcomes.

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