The study is a prospective randomized controlled trial comparing the efficacy and safety of propofol-ketamine ("Ketofol") versus propofol monotherapy in geriatric ICU patients. Eligible participants are critically ill elderly patients with a history of cardiac disease who require endotracheal intubation and have not yet received sedation. The investigators focus on a specific population in which geriatric patients have different pharmacokinetics and pharmacodynamics and are more prone to side effects than other populations.
Primary outcome: Incidence of hemodynamic instability (defined as hypotension requiring vasopressors), measured by mean arterial pressure (MAP) at baseline, during intubation, and post-intubation at 1, 3, 5, 10, 20, 30, and 60 minutes, then hourly for 24 hours.
Age ≥ 65 years
Admitted to ICU with a diagnosis of infection (sepsis, septic shock, or pneumonia)
Known history of cardiac disease (e.g., ischemic heart disease, heart failure, arrhythmias)
Requiring endotracheal intubation for airway protection or respiratory failure
Known allergy or contraindication to propofol or ketamine
Severe hepatic or renal dysfunction (Child-Pugh C, eGFR < 30 mL/min/1.73m²)
Uncontrolled hypertension (SBP > 180 mmHg or DBP > 110 mmHg)
Intracranial pathology (e.g., raised intracranial pressure, recent stroke, brain tumor)
Parallel
Ketofol
DrugPatients will take bolus dose of Propofol 0.25 mg/kg + Ketamine 0.25mg/kg If patient NOT sedated and need additional doses will be given another Propofol 0.25 mg/kg + Ketamine 0.25mg/kg IV
propofol (drug)
DrugPropofol given normal doses for intubation but at reduced and gradual dosing regimen regarding geriatric patient
Mean arterial blood pressure
hemodynamic stability, defined as MAP measured Baseline then during and post intubation at 1min , 3min , 5min 10min, 20min , 30min , 60min then hourly for 24h.
Time to successful intubation
Time to successful intubation (from induction to tube placement confirmation
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