STUDY OBJECTIVE Acute behavioral disturbance is characterized by altered mental status and psychomotor agitation. Pharmacological sedation may be required, risking potential respiratory compromise. We compared the need for emergent airway support following administration of midazolam or ketamine to treat acute behavioral disturbance in the out-of-hospital setting. METHODS In this retrospective cohort study of patients with acute behavioral disturbance in an urban emergency medical service system between 2017 and 2021, we compared the likelihood of out-of-hospital advanced airway management following administration of midazolam or ketamine. Advanced airway management was defined as out-of-hospital endotracheal intubation or supraglottic airway insertion. RESULTS Among 376 eligible patients, the median age was 35, and 78% were men. The most common etiologies of acute behavioral disturbance were substance use (51%), trauma (18%), and presumed postictal agitation (11%). In all, 162 patients (43%) initially received midazolam and 214 (57%) ketamine. The frequency of advanced airway management was similar between these respective groups (12% [n=19] versus 11% [n=24], difference 0.5%, 95% CI -6.0% to 7.0%). Adjusted for potential confounders, the odds of receiving advanced airway management did not differ between midazolam and ketamine (aOR 1.02, 95% CI 0.44 to 2.38), and no differences were observed in emergency department intubation rates (14% in midazolam recipients, 11% for ketamine) or overall mortality (2% in midazolam recipients, 1% for ketamine). CONCLUSION In this cohort study of patients with acute behavioral disturbance, emergent airway support and other outcomes did not differ following out-of-hospital treatment with midazolam or ketamine.

中文翻译：

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氯胺酮与咪达唑仑治疗院外急性行为障碍的比较。


研究目的 急性行为障碍的特征是精神状态改变和精神运动性激越。可能需要药物镇静，有可能导致呼吸功能受损的风险。我们比较了使用咪达唑仑或氯胺酮治疗院外急性行为障碍后紧急气道支持的需求。方法 在这项对 2017 年至 2021 年城市紧急医疗服务系统中急性行为障碍患者的回顾性队列研究中，我们比较了给予咪达唑仑或氯胺酮后院外高级气道管理的可能性。高级气道管理定义为院外气管插管或声门上气道插入。结果 在 376 例符合条件的患者中，中位年龄为 35 岁，其中 78% 为男性。急性行为障碍最常见的病因是物质使用 （51%） 、创伤 （18%） 和推测的发作后激越 （11%）。总共有 162 名患者 （43%） 最初接受了咪达唑仑治疗，214 名 （57%） 接受了氯胺酮治疗。这些组之间的高级气道管理频率相似 （12% [n=19] vs 11% [n=24]，差异 0.5%，95% CI -6.0% 至 7.0%）。根据潜在的混杂因素进行调整后，咪达唑仑和氯胺酮之间接受高级气道管理的几率没有差异 （aOR 1.02,95% CI 0.44 至 2.38），并且在急诊科插管率 （咪达唑仑接受者为 14%，氯胺酮为 11%） 或总死亡率 （咪达唑仑接受者为 2%，氯胺酮为 1%） 方面未观察到差异。结论 在这项针对急性行为障碍患者的队列研究中，院外接受咪达唑仑或氯胺酮治疗后紧急气道支持和其他结局没有差异。