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)