921: Ketamine in Critically Ill Adult Patients: Use, Perceptions, and Barriers

Magee, Carolyn; Hammond, Drayton A.; Rech, Megan A.; Mueller, Scott W.; Patel, Gourang; McMurray, Jeffrey; Kasotakis, George; Moses, Benjamin; Roberts, Russel J.; Akuamoah-Boateng, Kwame; Sakhuja, Ankit; Setliff, Erika; Droege, Christopher

doi:10.1097/01.ccm.0000729572.01354.52

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“…Ketamine, with its lack of effect on respiratory drive and low propensity to cause hypotension or coma, has advantages over opioids and propofol in critically ill adults requiring analgosedation ( 1 , 2 ). Ketamine is increasingly being used to optimize ICU patient comfort and safety ( 3 ) despite the current lack of a large, multicenter, controlled trial evaluating its analgosedation safety and efficacy ( 3 ). The pharmacology of ketamine is complex, and dose-dependent: analgesic effects usually predominate at lower doses (0.1–0.4 mg/kg/hr) and sedative effects at higher doses (0.4–1.0 mg/kg/hr) ( 1 , 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults

Kooken

et al. 2021

Critical Care Explorations

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OBJECTIVES: Ketamine is increasingly being used for analgosedation, but its effect on delirium remains unclear. We compared delirium risk variables and ketamine analgosedation use between adults who developed incident delirium and those who did not, evaluated whether ketamine analgosedation increases delirium risk, and compared ICU delirium characteristics, treatments, and outcomes between ketamine and nonketamine patients with delirium. DESIGN: Secondary, subgroup analysis of a cohort study. SETTING: Single, 36-bed mixed medical-surgical ICU in the Netherlands from July 2016 to February 2020. PATIENTS: Consecutive adults were included. Patients admitted after elective surgery, not expected to survive greater than or equal to 48 hours, admitted with delirium, or where delirium occurred prior to ketamine use were excluded. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Trained ICU nurses evaluated patients without coma (Richmond Agitation Sedation Scale. –4/–5) every 8 hours with the Confusion Assessment Method ICU; a delirium day was defined by greater than or equal to1 + Confusion Assessment Method ICU and/or scheduled antipsychotic use. Among 11 variables compared between the delirium and nondelirium groups (Baseline: age, Charlson Comorbidity score, cognitive impairment, admission type, and Acute Physiology and Chronic Health Evaluation-IV score, daily ICU [until delirium occurrence or discharge]: Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) and total ICU days, 7 (age, Charlson score, Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) were significantly different and were entered, along with delirium occurrence, in a logistic regression model. A total of 332 of 925 of patients (36%) developed delirium. Ketamine use was greater in patients with delirium (54 [16%] vs 4 [0.7%]; p < 0.01). Ketamine use (adjusted odds ratio, 5.60; 95% CI, 1.09–29.15), age (adjusted odds ratio, 1.03; 95% CI, 1.01–1.06), coma (adjusted odds ratio, 2.10; 95% CI, 1.15–3.78), opioid use (adjusted odds ratio, 171.17; 95% CI, 66.45–553.68), and benzodiazepine use (adjusted odds ratio, 34.07; 95% CI, 8.12–235.34) were each independently and significantly associated with increased delirium. Delirium duration, motoric subtype, delirium treatments, and outcomes were not different between the ketamine and nonketamine groups. CONCLUSIONS: Ketamine analgosedation may contribute to increased ICU delirium. The characteristics of ketamine and nonketamine delirium are similar. Further prospective research is required to evaluate the magnitude of risk for delirium with ketamine use.

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Section: Discussionmentioning

confidence: 99%

“…Ketamine, an anesthetic with both analgesic and sedative properties, is increasingly being used in both surgical and medical critically ill adults for analgosedation ( 1 – 3 ). Delirium, a common sequela of critical illness, is associated with poor outcomes ( 4 ).…”

mentioning

confidence: 99%

Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults

Kooken

et al. 2021

Critical Care Explorations

View full text Add to dashboard Cite

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921: Ketamine in Critically Ill Adult Patients: Use, Perceptions, and Barriers

Cited by 1 publication

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Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults

Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults

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