1107

Abstract

Introduction: The number of sedative options for use in mechanically ventilated patients remains limited. Ketamine is an NMDA antagonist with sedative, analgesic and bronchodilator properties. It also demonstrates favorable hemodynamic and pharmacokinetic profiles. While used commonly intra-operatively and by emergency room clinicians, a precedent for ketamine use in the intensive care unit is lacking outside of brief non-surgical procedures and rapid sequence intubation. Hypothesis: Continuous infusion ketamine can be utilized safely for adjunctive analgesia and sedation in mechanically ventilated medical intensive care unit patients. Methods: All patients who received continuous infusion ketamine for adjunctive sedation and analgesia between 1/1/2010 and 7/1/2012 were retrospectively identified via an informatics query. Patient demographics, process of care data and hemodynamic variables were collected and assessed. Results: Twelve patients met criteria. Mean age was 41; 60% were Caucasian and 60% were female. Median weight was 100kg. Four patients were known polysubstance abusers. Six patients were admitted for HCAP, three for asthma exacerbation. The median duration of ketamine therapy was 1.57 days. The median minimum and maximum rates were 0.24 mg/kg/hr and 0.83 mg/kg/hr. The median rate over the first 24h of infusion was 0.56 mg/kg/hr. The maximum documented dose used was 2.8 mg/kg/hr. The ketamine infusion was discontinued secondary to tachycardia or hypertension in two patients. One patient was receiving only concomitant propofol, the other dexmedetomidine and fentanyl infusions. No patient who received concomitant benzodiazepines experienced hemodynamic changes prompting ketamine cessation. Median maximum SBP, DBP, and HR while on ketamine were 154, 96 and 121, respectively. No further ADRs were identified, including rash, although 83% of patients received concurrent corticosteroids for their underlying illness. Conclusions: Continuous infusion ketamine may likely be utilized safely as adjunctive sedative and analgesic therapy in mechanically ventilated MICU patients if concomitant benzodiazepine therapy is provided. Larger trials are needed to further define optimal dosing and confirm safety.