Impact of Low-Dose Ketamine on the Usage of Continuous Opioid Infusion for the Treatment of Pain in Adult Mechanically Ventilated Patients in Surgical Intensive Care Units

Jessica L. Buchheit, Daniel Dante Yeh, Matthias Eikermann, Hsin Lin

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Ketamine at subanesthetic doses has been shown to provide analgesic effects without causing respiratory depression and may be a viable option in mechanically ventilated patients to assist with extubation. The aim of this study was to evaluate the effects of low-dose ketamine on opioid consumption in mechanically ventilated adult surgical intensive care unit (ICU) patients. Methods: A retrospective review of mechanically ventilated adult patients receiving low-dose ketamine continuous infusion (1-5 µcg/kg/min) for adjunctive pain control admitted to surgical ICUs was conducted. Patients were included if they met an ICU safety screen for a spontaneous breathing trial (SBT) implying extubation readiness pending SBT results. The primary end point was the slope of change in morphine equivalents (MEs) 12 hours pre- and postketamine infusion. We hypothesized that low-dose ketamine would increase the slope of opioid dose reduction. Results: Forty patients were analyzed. The median dose of ketamine was 5 µg/kg/min (interquartile range [IQR]: 3.5-5) and the treatment duration was 1.89 days (IQR: 0.96-3.06). Prior to ketamine, the majority of patients received volume-controlled or pressure-supported ventilation with a median duration of 2.05 days (IQR: 1.38-3.61). The median time from the initiation of ketamine to extubation was 1.44 days (IQR: 0.58-2.66). For the primary outcome, there was a significant difference in the slope of ME changes from 1 to −0.265 mg/h 12 hours pre- and postketamine initiation (P <.001). For the secondary outcomes, ketamine was associated with a decrease in vasopressor requirements (phenylephrine equivalent 70 vs 40 mg/h; P =.019). Conclusion: Low-dose continuous infusion ketamine in mechanically ventilated adult patients was associated with a significant increase in the rate of opioid dose reduction without adverse effects on hemodynamic stability.

Original languageEnglish (US)
Pages (from-to)646-651
Number of pages6
JournalJournal of Intensive Care Medicine
Volume34
Issue number8
DOIs
StatePublished - Aug 1 2019
Externally publishedYes

Keywords

  • low-dose ketamine
  • mechanical ventilation
  • opioid
  • surgical intensive care unit

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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