Ketamine-induced cholangiopathy in ARDS patients

Excerpt

We read with interest the letter by Meersseman and colleagues [1]. The group reports four other cases of secondary sclerosing cholangitis (SCC) in critically ill coronavirus disease 2019 (COVID-19) patients, which suggests that critically ill COVID-19 patients could be at risk for SCC [2]. Risk factors of SCC in critically ill patients include biliary ischemia, high positive end-expiratory pressure, drug-induced bile duct injury and systemic inflammation [1]. There is mounting evidence that ketamine could contribute to SCC in critically ill, including COVID-19, patients. Ketamine has been widely used as a second-line sedative agent in intensive care units (ICUs) during the COVID-19 pandemic [2, 3]. In 2021, Bütikofer and colleagues compared 34 critically ill COVID-19 patients with 34 critically ill influenza patients [4]. Four patients in the COVID-19 group developed SCC compared to none in the influenza group despite a higher severity of influenza patients (i.e., higher sepsis related organ failure assessment (SOFA) score, higher simplified acute physiology (SAP) score II). All patients received ketamine in the COVID-19 group and none in the influenza group. …