PURPOSE: Little is known about the potential hemodynamic benefits of continuous ketamine sedation and analgesia in adult ICU patients.
METHODS: In a pilot multi-center, prospective, double-blind, randomized controlled trial (Supported by a grant from the American Lung Association) we screened 66 adult ICU patients who required sedation and analgesia. Patients meeting entry criteria were randomized to continuous infusion of ketamine or fentanyl for ≥24 hours to achieve a Ramsay Sedation Scale of “4”.
RESULTS: In addition to demographic data, we recorded mean blood pressure, (MBP), heart rate, requirements of any intravenous (IV) vasopressor and airway resistance. Sixty % of patients (3/5) received ketamine with low dose midazolam for 24 hours followed by midazolam only, while 40% (2/5) received fentanyl infusion. MAP was statistically significant higher in the study compare to the control group (p<.05), figure 1. Furthermore, patients who received ketamine did not required any additional vasopressors & were less likely to be diagnosed with shock state, comparing to the fentanyl group (p<.05). In addition, we measured the airway resistance for both groups prior to both sedatives infusion and every four hours thereafter. There was statistically significant decrease in the airways resistance in the study group compared to the control group with (30±2.2%, % vs. 58.3±2.8 p<.05). Furthermore there was a trend for less need for bronchodilators use in the study group vs. the control group, but that was not statistically significant (p=0.13). With the unique design of the study, there were no complications after ketamine infusion including hallucinations or nightmares.
CONCLUSION: This preliminary report illustrated the possible value of ketamine for continuous ICU sedation and analgesia with more stable or improvement in MBP, decreased need for IV vasopressors and decrease in airway resistance in the study group.
CLINICAL IMPLICATIONS: The results of our ongoing study will provide more information about the impact of ketamine in early weaning from mechanical ventilation and hence decrease in ICU length of stay.
DISCLOSURE: Elamin Elamin, No Financial Disclosure Information; No Product/Research Disclosure Information