Ketamine use in sedation management in patients receiving extracorporeal membrane oxygenation

Medicating patients during extracorporeal membrane oxygenation: the evidence is building

“…Two uncontrolled studies demonstrated reductions in sedative rates with the addition of low‐dose ketamine infusions [24, 25]. Most recently, a randomized trial did not show any differences in opioid or sedative requirements with the addition of low‐dose ketamine to standard sedation practices as compared to standard sedation practices alone in patients receiving venovenous ECMO for severe respiratory failure [26]. Standard sedation practices consisted of infusions of fentanyl or hydromorphone and midazolam to achieve a Richmond Agitation Sedation Scale (RASS) of −5 at the initiation of ECMO.…”

“…Standard sedation practices consisted of infusions of fentanyl or hydromorphone and midazolam to achieve a Richmond Agitation Sedation Scale (RASS) of −5 at the initiation of ECMO. The median cumulative amount of fentanyl and midazolam equivalents in the low‐dose ketamine group were almost twice and four times as high, respectively, when compared to the control group from ECMO initiation to the decision to achieve wakefulness [26]. However, patients receiving low‐dose ketamine infusion had similar improvements in their RASS scores over the 72‐hours after the decision to achieve wakefulness [26].…”

Perspectives on adjunctive use of ketamine for analgosedation during extracorporeal membrane oxygenation

“…In contrast, Dzierba et al [14] reported that in a small study of 20 patients (N = 10 standard sedation practice = control group; N = 10 standard sedation practice plus low dose ketamine infusion = protocol group), the addition of ketamine to standard sedation did not reduce the use of sedatives or opioids. Despite these findings, patients' receiving low-dose ketamine infusion had similar improvements in their RASS scores over the 72 h after decision to achieve wakefulness (DTAW).…”

Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

“…Consideration of adjunctive agents such as low doses of ketamine may improve wakefulness and augment opioid analgesia without changing sympathetic tone and were recently recommended in guidelines to reduce opioid consumption in postsurgical adult patients . A randomized controlled pilot trial of standard sedation practices with or without low‐dose ketamine infusion in patients receiving venovenous ECLS for severe respiratory failure did not observe a significant reduction in opioid or sedative requirements . Because ketamine is moderately lipophilic (log p = 2.9) and protein bound (27%), the doses of ketamine used in the aforementioned trial were possibly not high enough to overcome ECLS‐induced pharmacokinetic changes, and larger trials using various doses need to be conducted to confirm these observations.…”