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

2017 ◽  
Vol 34 (8) ◽  
pp. 646-651 ◽  
Author(s):  
Jessica L. Buchheit ◽  
Daniel Dante Yeh ◽  
Matthias Eikermann ◽  
Hsin Lin
Keyword(s):  
Intensive Care ◽  
Continuous Infusion ◽  
Dose Reduction ◽  
Low Dose ◽  
Adult Patients ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Opioid Dose ◽  
Ventilated Patients

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.

scholarly journals Cerebrospinal Fluid Penetration and Pharmacokinetics of Vancomycin Administered by Continuous Infusion to Mechanically Ventilated Patients in an Intensive Care Unit

2000 ◽  
Vol 44 (5) ◽  
pp. 1356-1358 ◽  
Author(s):  
Jacques Albanèse ◽  
Marc Léone ◽  
Bernard Bruguerolle ◽  
Marie-Laure Ayem ◽  
Bruno Lacarelle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cerebrospinal Fluid ◽  
Intensive Care ◽  
Continuous Infusion ◽  
The Other ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Csf Penetration ◽  
Group Serum ◽  
Ventilated Patients

ABSTRACT Cerebrospinal fluid (CSF) penetration and the pharmacokinetics of vancomycin were studied after continuous infusion (50 to 60 mg/kg of body weight/day after a loading dose of 15 mg/kg) in 13 mechanically ventilated patients hospitalized in an intensive care unit. Seven patients were treated for a sensitive bacterial meningitis and the other six patients, who had a severe concomitant neurologic disease with intracranial hypertension, were treated for various infections. Vancomycin CSF penetration was significantly higher (P< 0.05) in the meningitis group (serum/CSF ratio, 48%) than in the other group (serum/CSF ratio, 18%). Vancomycin pharmacokinetic parameters did not differ from those obtained with conventional dosing. No adverse effect was observed, in particular with regard to renal function.

Correlation of Pneumonia Score with Electronic Nose Signature: A Prospective Study

2005 ◽  
Vol 114 (7) ◽  
pp. 504-508 ◽  
Author(s):  
Neil G. Hockstein ◽  
Erica R. Thaler ◽  
Yuanqing Lin ◽  
D. Daniel Lee ◽  
C. William Hanson
Keyword(s):  
Intensive Care ◽  
Prospective Study ◽  
Electronic Nose ◽  
Arterial Oxygen ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
A Prospective Study ◽  
Ventilated Patients

Objectives: Ventilator-associated pneumonia (VAP) is a frequent complication in patients in surgical intensive care units. Pneumonia scores, chest radiography, and bronchoscopy are all employed, but there is no gold standard test for the diagnosis of VAP. The electronic nose, a sensor of volatile molecules, is well suited to testing the breath of mechanically ventilated patients. Our objective was to determine the potential use of an electronic nose as a diagnostic adjunct in the detection of VAP. Methods: We performed a prospective study of mechanically ventilated patients in a surgical intensive care unit. Clinical data, including temperature, white blood cell count, character and quantity of tracheal secretions, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, and chest radiographs, were collected, and a pneumonia score between 0 and 10 was calculated. Exhaled gas was sampled from the expiratory limb of the ventilator circuit. The gases were assayed with a commercially available electronic nose. Multidimensional data reduction analysis was used to analyze the results. Results: Forty-four patients were studied. Fifteen patients had pneumonia scores of 7 or greater, and 29 patients had scores of 6 or less. With Fisher discriminant analysis and K—nearest neighbor analysis, the electronic nose was able to discriminate between the two groups. Conclusions: The electronic nose is a new technology that is inexpensive, noninvasive, and portable. We demonstrate its ability to predict pneumonia, based on a well-recognized scoring system. This technology promises to serve as a diagnostic adjunct in the management of VAP.

Comparison of Ketamine- Versus Nonketamine-Based Sedation on Delirium and Coma in the Intensive Care Unit

2018 ◽  
Vol 35 (6) ◽  
pp. 536-541 ◽  
Author(s):  
Vanessa Shurtleff ◽  
John J. Radosevich ◽  
Asad E. Patanwala
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Adult Patients ◽  
Study Cohort ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background: At this time, there are no studies evaluating the risk of delirium or coma with the use of ketamine in mechanically ventilated adult patients, compared to conventional therapies such as propofol or dexmedetomidine. Objective: The objective of this study was to evaluate the number of days alive without delirium or coma in mechanically ventilated patients in the intensive care unit receiving analgosedation infusions with ketamine versus without ketamine. Methods: This was a retrospective cohort study conducted at an academic medical center in the United States. Consecutive mechanically ventilated adult patients between November 2015 and April 2017 were evaluated. Patients were divided into 2 groups based on the sedative regimen used: ketamine based or nonketamine based. The primary outcome was the number of days alive without delirium or coma. The secondary outcomes were incidence of delirium, incidence of coma, and ventilator-free days at day 28. Results: The study cohort consisted of 79 patients, of which 39 received ketamine- and 40 received nonketamine-based sedation. The number of days alive without delirium or coma was 6 days (interquartile range [IQR]: 2-9 days) with ketamine and 4 days (IQR: 3-7 days) with nonketamine ( P = .351). Delirium occurred in 29 (74%) of 39 patients with ketamine and 34 (85%) of 40 patients with nonketamine ( P = .274). Coma occurred in 16 (41%) of 39 patients with ketamine and 6 (15%) of 40 patients with nonketamine ( P = .013). The median ventilator-free days were 13 days (IQR: 0-23 days) with ketamine and 21 days (0-25 days) with nonketamine ( P = .229). Conclusions: Sustained ketamine-based sedation in mechanically ventilated patients may be associated with a higher rate of observed coma but similar delirium- and coma-free days compared nonketamine-based regimens.

scholarly journals The ethical concerns of seeking consent from critically ill, mechanically ventilated patients for research – A matter of possessing capacity or surrogate insight

2018 ◽  
Vol 13 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Avelino C Verceles ◽  
Waqas Bhatti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Informed Consent ◽  
Critically Ill ◽  
Ethical Issues ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ethical Concerns ◽  
Multiple Factors ◽  
Ventilated Patients

Conducting clinical research on subjects admitted to intensive care units is challenging, as they frequently lack the capacity to provide informed consent due to multiple factors including intensive care unit acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from mechanically ventilated, critically ill patients, in addition to the concerns that may arise when a legally authorized representative is asked to provide informed consent on behalf of these patients.

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