Good research question on ketamine

[otherstuff12321]

Hi all! I’m an intern, basically just started and haven’t even rotated in anesthesia yet. One of my faculty members offered to help me with research and asked for a research question. I was hoping to come up with something actually interesting and relevant to pursue, but don’t really have much experience yet to decide...

I’m really interested in ketamine and its use as sedation in ICU, and I noticed it’s tendency to cause tachycardia. It got me thinking about things like demand ischemia. So I was gonna go with something like:

“In adult patients admitted to the SICU, does long-term ketamine infusion compared to standard analgesic management with propofol over a 48-hour period lead to a statistically significant increase in cardiac injury markers, specifically elevated troponin levels?"

However, I saw quite a few articles already published on this and wasn’t sure how to take it a step further or do something novel with it.

Would y’all happen to have any suggestions on what to research with ketamine and it’s cardiovascular effects? Or how I could take this question a step further and make it unique?

I was thinking of maybe looking at pressor requirements for those on ketamine vs propofol in ICU setting post cardiac surgery, if that sounds practical. Or effects of ketamine on lactic acid levels compared to propofol in setting of sepsis in the ICU. Would that also make any sense?

Thank you 🙂

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[GassYous]

I think that looking at markers like trop or lactate is a waste of time. You should look at clinically significant outcomes, maybe something like time to extubation, length of stay in icu, inadvertent extubations, takeback rate.

 

[JOHNBROCHILL]

Is this some prospective study you are designing that needs protocols, ICU buy in, surgeon buy in, institution approval? Are you steering the ship as the intern? How strong is your mentor support? It doesn't matter much what your research question is if your project is going to fizzle out.

While I don't do research anymore I had many published projects as a resident so I'll give you some advice.
1. Find the person in your department who publishes. Bonus points if this is in a subspecialty you want to go into. Every department has a few that are prolific, find one of these people, this is the person you want to associate with.
2. Approach them in person, say you are interested and would love to help out with a project. They often have multiple things going on at once and will throw you on one of them to help. Now you are part of an established project that is hopefully going somewhere.
3. If the project involves data collection then your new goal is to recruit 2 medical students, this is easy through rotators and interest group clubs
4. Be helpful, responsive, do good work, they'll love you when you are a CA1 before they even see you in the OR

good luck

 

[chessknt]

If you want to dedicate your time to something useful dont use post CTSx patients as a population--surgeons control that population and execute utter nonsense 100% of the time (think lasix + fluids, insulin + dextrose, inotropes being titrated to malpositioned SGC etc). You just let them do it because they make so much money for the hospital you'll never get to tell them what to do. Find a different population.

Delirium and sedative selection has led away from benzodiazepine use but ketamine hasn't been studied head to head with precedex or proposal in that regard. Delirium is routinely tracked in icus. That is something potentially measurable if you can find someone to support protocolizing sedation but the big issue you're going to run in to is nursing compliance, especially at night.

 

[Radetzky]

Practicalities of running a clinical trial as an intern aside, don’t waste time studying outcomes of sedation in the icu. Deadend, even seasoned researchers have failed to find meaningful differences in outcomes. Hell we still don’t really know if ketamine causes delirium or not and that’s the main issue we worry about. We’re also up to like the 4th SPICE study.

 

[Ronin786]

Ketamine as an induction agent in the ICU could be a fruitful avenue of research. Too many IM/EM trained folks don't know how to use anything other than Etomidate to put patients to sleep.

 

[GassYous]

Ketamine as an induction agent in the ICU could be a fruitful avenue of research. Too many IM/EM trained folks don't know how to use anything other than Etomidate to put patients to sleep.

"Let's use etomidate!"
nurse - "Okay, what's the dose?"
"Hmm...let's do 20!"

 

[Arch Guillotti]

"Let's use etomidate!"
nurse - "Okay, what's the dose?"
"Hmm...let's do 20!"

Or 40.

 

[powermd]

Hi all! I’m an intern, basically just started and haven’t even rotated in anesthesia yet. One of my faculty members offered to help me with research and asked for a research question. I was hoping to come up with something actually interesting and relevant to pursue, but don’t really have much experience yet to decide...

I’m really interested in ketamine and its use as sedation in ICU, and I noticed it’s tendency to cause tachycardia. It got me thinking about things like demand ischemia. So I was gonna go with something like:

“In adult patients admitted to the SICU, does long-term ketamine infusion compared to standard analgesic management with propofol over a 48-hour period lead to a statistically significant increase in cardiac injury markers, specifically elevated troponin levels?"

However, I saw quite a few articles already published on this and wasn’t sure how to take it a step further or do something novel with it.

Would y’all happen to have any suggestions on what to research with ketamine and it’s cardiovascular effects? Or how I could take this question a step further and make it unique?

I was thinking of maybe looking at pressor requirements for those on ketamine vs propofol in ICU setting post cardiac surgery, if that sounds practical. Or effects of ketamine on lactic acid levels compared to propofol in setting of sepsis in the ICU. Would that also make any sense?

Thank you 🙂

Here's an idea for you: the effects of intraop IV ketamine on postop analgesic use, self-reported pain, and functional scales in patients with fibromyalgia having orthopedic surgery. Follow up should go out six months to see the impact on the development of chronic pain. Your sample size probably won't be large enough to detect impact on CRPS development, but I'd be curious about that too.

 

[woopedazz]

Why bother when you can just really on the results of ROCKET trial some time soon?