Discontinuance of Life Sustaining Treatment Utilizing Ketamine for Symptom Management

Noreika, Danielle; Coyne, Patrick

doi:10.3109/15360288.2014.1003686

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…The use of non-opioid medications can reduce opioid requirements and their side effects, such as pruritus, nausea, and constipation, which are undesirable during the end-of-life process. Several case reports have shown positive effects of medications such as ketamine, dexmedetomidine, and regional anesthesia at the end-of-life in the ICU [ 50 – 52 ], but the lack of clinical studies and practice parameters limits the applicability of this approach in patients at the end-of-life, and thus, further investigation should be prioritized.…”

Section: Discussionmentioning

confidence: 99%

Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis

et al. 2020

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To review and summarize the most frequent medications and dosages used during withholding and withdrawal of life-prolonging measures in critically ill patients in the intensive care unit. Methods: We searched PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Virtual Health Library from inception through March 2019. We considered any study evaluating pharmaceutical interventions for pain management during the withholding or withdrawing of life support in adult critically ill patients at the end-oflife. Two independent investigators performed the screening and data extraction. We pooled data on utilization rate of analgesic and sedative drugs and summarized the dosing between the moment prior to withholding or withdrawal of life support and the moment before death. Results: Thirteen studies met inclusion criteria. Studies were conducted in the United States (38%), Canada (31%), and the Netherlands (31%). Eleven studies were single-cohort and twelve had a Newcastle-Ottawa Scale score of less than 7. The mean age of the patients ranged from 59 to 71 years, 59-100% were mechanically ventilated, and 47-100% of the patients underwent life support withdrawal. The most commonly used opioid and sedative were morphine [utilization rate 60% (95% CI 48-71%)] and midazolam [utilization rate 28% (95% CI 23-32%)], respectively. Doses increased during the end-of-life process (pooled mean increase in the dose of morphine: 2.6 mg/h, 95% CI 1.2-4). Conclusions: Pain control is centered on opioids and adjunctive benzodiazepines, with dosages exceeding those recommended by guidelines. Despite consistency among guidelines, there is significant heterogeneity among practices in end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis

et al. 2020

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“…In another case report under different circumstances, ketamine was also satisfactorily used for palliative sedation and symptom management in a patient on very high doses of opioids and sedatives prior to discontinuation of life-sustaining ECMO treatment [15].…”

Section: Ketamine During Ecmo Supportmentioning

confidence: 99%

Perspectives on adjunctive use of ketamine for analgosedation during extracorporeal membrane oxygenation

Maybauer

Koerner

Maybauer

2019

Expert Opinion on Drug Metabolism & Toxicology

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Analgosedation on ECMO is more than the choice of any drug, it has to be context specific. Ketamine may be considered as an adjunctive therapy in patients requiring high-dose opioids and sedatives during ECMO support with difficulty to achieve a target RASS. Considering ketamine provides analgesia while maintaining airway reflexes, it could be useful for early ECMO weaning and use of ECMO in awake, non-intubated, spontaneously breathing patients with respiratory failure ('awake' ECMO), especially for patients having considerable waiting periods while being bridged to transplant. The hemodynamic effects of ketamine may provide the benefit of decreasing vasopressor requirements, thereby potentially improving microcirculation. In this context, the effects on end-organ function and the need for renal replacement therapy should be investigated. Pharmacokinetic and pharmacodynamic studies on ketamine ex-and in vivo are of utmost importance to delineate its pharmacological profile and effectiveness during ECMO therapy and to create admissible future study hypothesis.

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Recent LiteratureFeature Editor: Paul C. Rousseau

2015

Journal of Palliative Medicine

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Discontinuance of Life Sustaining Treatment Utilizing Ketamine for Symptom Management

Cited by 4 publications

References 27 publications

Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis

Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis

Perspectives on adjunctive use of ketamine for analgosedation during extracorporeal membrane oxygenation

Recent LiteratureFeature Editor: Paul C. Rousseau

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