AN INSTITUTIONAL EXPERIENCE WITH KETAMINE INFUSION FOR ANALGOSEDATION IN THE MEDICAL ICU

Abstract

SESSION TITLE: Monday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: The use of ketamine infusion for analgosedation in the medical intensive care unit (MICU) has historically been an uncommon practice. However, interest in its use has increased in recent years due to its unique pharmacologic properties that appear to make the drug ideally suited to this purpose. However, sparse data on the safety and efficacy of this practice continues to limit its widespread adoption. This study assessed the impact of continuous ketamine infusion on requirements for other concomitant analgosedative and vasopressor agents. METHODS: This was a single-center retrospective study of patients who received continuous infusion of ketamine to facilitate mechanical ventilation in the MICU between May 1, 2015 and September 1, 2018. Infusion rates of other analgosedative and vasopressor agents, as well as Richmond Agitation and Sedation Scores (RASS), were collected at the time of ketamine initiation and at 12, 24, and 48-hour intervals thereafter. RESULTS: Of the 81 ketamine infusion patients screened, 60 met inclusion criteria for the analysis of vasopressor infusion rates, and 41 were included in the analysis of RASS and concomitant analgosedative infusion rates after excluding 19 patients who were receiving neuromuscular blockade. There was a prominent trend towards decreased requirements for other analgosedative agents following the introduction of ketamine infusion. This reached statistical significance for total number of analgosedative infusions running (n=41) at 24 hours (-22%; p=0.03) and 48 hours (-32.6%; p=0.003), propofol infusion rate (n=14) at 12 (-53.3%; p=0.006), 24 (-56.3%; p=0.005), and 48 hours (-75.2%; p=0.001), and fentanyl infusion rate (n=14) at 12 (-20.9%; p=0.05), 24 (-35.4%; p=0.009), and 48 hours (-58.2%; p=0.0005). These dose reductions were accomplished without a significant change in the percentage of RASS scores within goal range (-1 to +1) at each time point. In addition, ketamine initiation was followed by a trend towards reduced vasopressor requirements which reached statistical significance for norepinephrine infusion rate (n=23) at 48 hours (-76%; p=0.006). CONCLUSIONS: Despite small sample size, the initiation of ketamine infusion for analgosedation in MICU patients was associated with significantly decreased requirements for other concomitant analgosedative and vasopressor agents without impacting time within RASS goal. However, retrospective design and lack of a comparison group were major limitations to our study. Future studies are needed to assess these findings in a prospective randomized fashion. CLINICAL IMPLICATIONS: This study supports the use of ketamine infusion for analgosedation in mechanically ventilated MICU patients. Its use is linked with decreased requirements for other concomitant analgosedative and vasopressor agents. These findings may lead to the more frequent use of ketamine infusion for analgosedation in the MICU. DISCLOSURES: No relevant relationships by Michael Cardone, source=Web Response No relevant relationships by Bruce Doepker, source=Web Response No relevant relationships by Gregory Eisinger, source=Web Response No relevant relationships by Jessica Elefritz, source=Web Response No relevant relationships by Matthew Exline, source=Web Response No relevant relationships by Matthew Huang, source=Web Response No relevant relationships by Jennifer McCallister, source=Web Response