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)
Study at a glance
AI-extracted from the abstract| 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 Esketamine |
| Keywords | Sedation sedatives Sedating Sedated Icu Delirium acute confusion Encephalopathy Pharmacology medications Drugs Benzodiazepines benzos |
| Citations | 3 |
| Key findings | 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.
Comparable studies
Other observational and cohort studies on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Taming the Ketamine Tiger Volunteers from a prison population | 2010 | Observational study | n = 20 |
| Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans | 2017 | Observational study | |
| Disruption of Frontal–Parietal Communication by Ketamine, Propofol, and Sevoflurane Surgical patients undergoing induction of anesthesia with intravenous ketamine | 2013 | Observational cohort | n = 30 |
| Do the dissociative side effects of ketamine mediate its antidepressant effects? Treatment-resistant inpatients with major depressive disorder or bipolar disorder | 2014 | Observational cohort | n = 108 |
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |