Continuous infusion ketamine for sedation of mechanically ventilated adults in the intensive care unit: A scoping review

Richards, Nicholas David; Weatherhead, William; Howell, Simon; Bellamy, Mark; Mujica-Mota, Ruben

doi:10.1177/17511437231182507

Cited by 5 publications

(1 citation statement)

References 53 publications

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“…Patients with PICS commonly experience a high occurrence of depression, anxiety, PTSD, and sleep difficulties, which result in long-term disability [41]. Ketamine has been regarded as an alternate antipsychotic and sedative drug for treating PTSD, especially in patients with asthma and hypotension [45]. Quetiapine and risperidone, both classified as atypical antipsychotic medicines, are commonly prescribed in therapeutic settings.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

Ekong,

Monga,

Daher

et al. 2024

Cureus

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Post-intensive care syndrome (PICS) is the term used to describe the decline in the physical, cognitive, and/or mental condition of individuals who have been discharged from the intensive care unit (ICU). This complication could result in a significant reduction in quality of life, with some patients experiencing symptoms of prolonged weakness, depression, anxiety, and post-traumatic stress disorder (PTSD). Intensive care advancement over the years has resulted in an increase in ICU survival rates and a proportional increase in PICS, creating a need for more in-depth research into the prevention and management of the disease. Hence, this study aims to examine the present body of literature on PICS, encompassing its underlying physiological processes and elements that contribute to its development, methods for evaluating and diagnosing the condition, current treatment choices as well as potential new approaches, and the constraints in managing PICS and the necessity for further investigation. In this article, studies were compiled from several databases, including, but not limited to, Google Scholar, PubMed, and Cochrane Library. These studies were reviewed, and their data were used to highlight important aspects regarding the efficacy of current PICS screening tools, the optimization and limitations of both pharmacologic and nonpharmacologic treatment methods, and the feasibility and safety of emerging treatments and technologies. The major conclusions of this review were centered around the need for multidisciplinary management of PICS. From pharmacological management using analgesia to non-pharmacological management using early mobilization and exercise therapy, the effective treatment of PICS requires a multifaceted approach. Patient follow-up and its importance were touched upon, including strategies and policies to bolster proper followup, thereby increasing favorable outcomes. Lastly, the importance of family involvement and the increased need for research into this topic were highlighted.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

Ekong,

Monga,

Daher

et al. 2024

Cureus

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Ketamine analgo‐sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine

Amer,

Møller,

Alshahrani

et al. 2024

Acta Anaesthesiol Scand

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BackgroundThis Rapid Practice Guideline (RPG) aimed to provide evidence‐based recommendations for ketamine analgo‐sedation (monotherapy and adjunct) versus non‐ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research.MethodsThe RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up‐to‐date systematic review and meta‐analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence‐to‐decision framework were used to assess the certainty of evidence and to move from evidence to decision/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients' values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities.ResultsData from 17 randomized clinical trials (n = 898) and nine observational studies (n = 1934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo‐sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28 days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] −0.05 days; 95% CI −0.07 to −0.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg/kg/h morphine equivalent) (MD −11.6; 95% CI −20.4 to −2.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient‐important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied.ConclusionThe RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo‐sedation in critically ill adults on iMV when other analgo‐sedatives are available; and (2) using ketamine as an adjunct to non‐ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non‐ketamine usual care sedatives alone. Large‐scale trials should provide additional evidence.

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Ketamine Analgo-sedation for Mechanically Ventilated Critically Ill Adults: A Rapid Practice Guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine

Amer,

Hylander Møller,

Alshahrani

et al. 2024

Anesthesia &Amp; Analgesia

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Background: This Rapid Practice Guideline (RPG) aimed to provide evidence‑based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research. Methods: The RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up-to-date systematic review and meta-analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence-to-decision framework were used to assess the certainty of evidence and to move from evidence to decision/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients’ values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities. Results: Data from 17 randomized clinical trials (n=898) and 9 observational studies (n=1934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo-sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28 days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] -0.05 days; 95% CI -0.07 to -0.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg/kg/h morphine equivalent) (MD -11.6; 95% CI -20.4 to -2.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient-important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied. Conclusion: The RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo-sedation in critically ill adults on iMV when other analgo-sedatives are available; and (2) using ketamine as an adjunct to non-ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non-ketamine usual care sedatives alone. Large-scale trials should provide additional evidence.

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Continuous infusion ketamine for sedation of mechanically ventilated adults in the intensive care unit: A scoping review

Cited by 5 publications

References 53 publications

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

Ketamine analgo‐sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine

Ketamine Analgo-sedation for Mechanically Ventilated Critically Ill Adults: A Rapid Practice Guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine

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