2Department of Intensive Care Unit, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
3Department of Pulmonology, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
4Department of Anesthesiology and Reanimation, University of Health Sciences, İstanbul Training and Research Hospital, İstanbul, Türkiye
BACKGROUND AND AIM: Ketamine is a fast-acting, hypnotic, amnestic agent that may be used to manage pain and agitation which is refractory to commonly used sedatives and analgesics. However, there is a paucity of literature describing the effects of continuous infusion of ketamine on sedative and analgesic consumption and delirium in mechanically ventilated patients. This investigation describes a single institution’s use of ketamine infusions as a part of a sedation protocol in the respiratory intensive care unit (RICU).
METHODS: This was a retrospective cohort study of mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) who received ketamine infusions as a part of a sedation protocol in a 16-bed RICU. The patients have assessed sedative consumption, analgesic consumption, and delirium incidence.
RESULTS: A total of 100 COPD patients receiving ketamine continuous infusion as a part of a sedation protocol between November 2017 and April 2020 were eligible and enrolled in this study. We found that patients had a reduction in opioid and benzodiazepine requirements at 24, 48, and 72 h after ketamine initiation (p<0.05). In addition, significant reductions in vasopressor requirements were observed at 24, 48, and 72 h after ketamine initiation (p<0.05). During the analyzed time frame, all patients received ketamine infusion at 4 μg/kg/min. There were no reported adverse drug reactions.
CONCLUSIONS: In this cohort of COPD patients who required mechanical ventilation we found decreased benzodiazepine, opiate, and vasopressor doses when the addition of a ketamine infusion, with no adverse drug reactions. Further prospective research is warranted to define optimal dosing strategies.