Impact of Continuous Infusion Ketamine Compared to Continuous Infusion Benzodiazepines on Delirium in the Intensive Care Unit.
Nicholas J Vollmer, Erin D Wieruszewski, Andrea M Nei, Kristin C Mara, Alejandro A Rabinstein, Caitlin S Brown
Journal of Intensive Care Medicine December 1, 2024 DOI: 10.1177/08850666241253541 (opens in new tab) via PubMed
Summary
AI-generated from the abstractAmong critically ill, mechanically ventilated patients, continuous infusion of sedative-dose ketamine did not improve delirium- or coma-free days compared with continuous infusion of benzodiazepines. The median number of delirium- or coma-free days within the first 28 days was 1.2 for ketamine and 1.8 for benzodiazepines, a difference that was not statistically significant. Patients receiving ketamine spent less time at a desired sedation level, received more propofol and fentanyl, and had a longer intensive care unit stay. The findings suggest that ketamine offers no advantage over benzodiazepines for reducing delirium or coma in this population.
Study at a glance
| Characteristics | Retrospective cohort Peer reviewed |
|---|---|
| Sample size | 165 |
| Population | Mechanically ventilated adults in the intensive care unit receiving continuous infusion sedative-dose ketamine or benzodiazepines for at least 24 hours |
| Intervention | Continuous infusion sedative-dose ketamine |
| Duration | 28-day follow-up |
| Topics | Ketamine |
| Keywords | Sedation sedatives Sedating Sedated Icu |
| Citations | 3 |
| Key finding | Continuous infusion sedative-dose ketamine did not significantly differ from benzodiazepines in delirium- or coma-free days among critically ill, mechanically ventilated patients. |
Abstract
Purpose: The purpose of this study was to evaluate rates of delirium or coma-free days between continuous infusion sedative-dose ketamine and continuous infusion benzodiazepines in critically ill patients. Materials and Methods: In this single-center, retrospective cohort adult patients were screened for inclusion if they received continuous infusions of either sedative-dose ketamine or benzodiazepines (lorazepam or midazolam) for at least 24 h, were mechanically ventilated for at least 48 h and admitted to the intensive care unit of a large quaternary academic center between 5/5/2018 and 12/1/2021. Results: A total of 165 patients were included with 64 patients in the ketamine group and 101 patients in the benzodiazepine group (lorazepam n = 35, midazolam n = 78). The primary outcome of median (IQR) delirium or coma-free days within the first 28 days of hospitalization was 1.2 (0.0, 3.7) for ketamine and 1.8 (0.7, 4.6) for benzodiazepines (p = 0.13). Patients in the ketamine arm spent a significantly lower proportion of time with RASS -3 to +4, received significantly higher doses and longer durations of propofol and fentanyl infusions, and had a significantly longer intensive care unit length of stay. Conclusions: The use of sedative-dose ketamine had no difference in delirium or coma-free days compared to benzodiazepines.