PMID- 28468568 OWN - NLM STAT- MEDLINE DCOM- 20200108 LR - 20220408 IS - 1525-1489 (Electronic) IS - 0885-0666 (Linking) VI - 34 IP - 8 DP - 2019 Aug TI - 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. PG - 646-651 LID - 10.1177/0885066617706907 [doi] AB - 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 microcg/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 microg/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. FAU - Buchheit, Jessica L AU - Buchheit JL AD - 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA. FAU - Yeh, Daniel Dante AU - Yeh DD AD - 2 Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA. FAU - Eikermann, Matthias AU - Eikermann M AD - 3 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA. FAU - Lin, Hsin AU - Lin H AD - 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA. LA - eng PT - Journal Article DEP - 20170503 PL - United States TA - J Intensive Care Med JT - Journal of intensive care medicine JID - 8610344 RN - 0 (Analgesics, Opioid) RN - 690G0D6V8H (Ketamine) RN - 76I7G6D29C (Morphine) SB - IM MH - Adult MH - Aged MH - Analgesics, Opioid/*administration & dosage/therapeutic use MH - Critical Care/*methods MH - Dose-Response Relationship, Drug MH - Drug Administration Schedule MH - Drug Therapy, Combination MH - Female MH - Humans MH - Infusions, Intravenous MH - Intensive Care Units MH - Ketamine/*administration & dosage/therapeutic use MH - Male MH - Middle Aged MH - Morphine/*administration & dosage/therapeutic use MH - Pain, Postoperative/*drug therapy MH - *Respiration, Artificial MH - Retrospective Studies MH - Treatment Outcome OTO - NOTNLM OT - low-dose ketamine OT - mechanical ventilation OT - opioid OT - surgical intensive care unit EDAT- 2017/05/05 06:00 MHDA- 2020/01/09 06:00 CRDT- 2017/05/05 06:00 PHST- 2017/05/05 06:00 [pubmed] PHST- 2020/01/09 06:00 [medline] PHST- 2017/05/05 06:00 [entrez] AID - 10.1177/0885066617706907 [doi] PST - ppublish SO - J Intensive Care Med. 2019 Aug;34(8):646-651. doi: 10.1177/0885066617706907. Epub 2017 May 3.