Courtney Hall, PharmD
Neurocritical Care Clinical Pharmacist
Ochsner Medical Center
Disclosure information not submitted.
Miranda Lackie, PharmD, BCCCP
Medical Intensive Care Unit Clinical Pharmacist
Ochsner Medical Center, United States
Disclosure information not submitted.
Yana Bukovskaya, PharmD, BCPS
Neurocritical Care Clinical Pharmacist
Ochsner Medical Center, United States
Disclosure information not submitted.
Katherine Jennings, PharmD, BCCCP
Medical Intensive Care Unit Clinical Pharmacist
Ochsner Medical Center, United States
Disclosure information not submitted.
Natalie Tucker, PharmD
Neurocritical Care Clinical Pharmacist
Ochsner Medical Center, United States
Disclosure information not submitted.
Giuseppe Ciccotto, MD, MPH
Neurointensivist
Ochsner Medical Center, United States
Disclosure information not submitted.
Shaun Yockelson, MD
Anesthesiologist, Intensivist
Ochsner Medical Center, United States
Disclosure information not submitted.
Title: Ketamine Infusion for Adjunct Sedation in SARS-CoV-2
Introduction: Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that blocks glutamate, producing both sedation and analgesia. It has many advantages when compared with conventional sedatives. Patients diagnosed with SARS-CoV-2 require high levels of sedation to ensure comfort and ventilator synchrony. Due to extended durations of mechanical ventilation and the risk of recurrent critical drug shortages, alternative options and additional guidance for sedation of mechanically ventilated SARS-CoV-2 patients is needed. The purpose of this study was to evaluate the impact of ketamine for sedation on the dosing of concomitant analgesic and sedative agents within the first 24 hours of ketamine initiation.
Methods: A retrospective, observational, chart review was conducted on 125 patients admitted to an Ochsner Health facility intensive care unit with a diagnosis of SARS-CoV-2. Patients must have been mechanically ventilated and received at least one continuous infusion analgesic or sedative agent in combination with ketamine for at least 24 hours. Patients were excluded if they received ketamine for non-sedation purposes or had ketamine initiated without the use of the sedation order-set. The primary end point of this study was percent change in total daily dose of concomitant sedative and analgesic infusions 24 hours after ketamine initiation.
Results: Among the 125 patients that were included, percent change in daily dose 24 hours post-ketamine initiation was decreased in patients who received concomitant fentanyl (-5.61 ± 0.7%; P = 0.001), midazolam (-6.98 ± 1.2%; P = 0.009), and propofol (-1.26 ± 0.7%; P = 0.36). Conversely, percent change in daily dose was increased in patients who received dexmedetomidine (3.28 ± 0.4%; P = 0.09) and hydromorphone (3.33 ± 0.3%; P= 0.63). Ventilator synchrony was increased 24 hours after initiation of ketamine (20 ± 0.05%; P = 0.06).
Conclusions: The use of continuous infusion ketamine for sedation led to a significant reduction in daily dose 24 hours post-ketamine initiation of fentanyl and midazolam in SARS-Cov-2 patients. Ventilator synchrony also trended towards improvement after the initiation of ketamine. These findings demonstrate that ketamine is efficacious and may act as a reasonable adjunct to more traditional sedatives and analgesics.