(974) Ketamine as a Sedative in the Trauma Intensive Care Unit

Introduction: The use of ketamine as an adjunctive sedative has increased due to its purported ability to reduce dosage requirements for sedative and analgesic medications. The data regarding the effect of ketamine on time within goal pain and sedation scores has conflicting results. The objective of this study was to characterize the use of ketamine as a sedative among adults admitted to the trauma intensive care unit (TICU).

Methods: This was a single-center retrospective study performed at University Hospitals Cleveland Medical Center. Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) scores, and total 24-hour dose of sedative, analgesic, and antipsychotic mediations were evaluated at 24-hour intervals pre and post ketamine initiation. Results were analyzed with descriptive statistics.

Results: A report of ketamine sedation orders in the TICU identified 83 subjects, and 43 patients were included in the study cohort. Patients were predominantly male (83.7%), young adults (median age 37 years), admitted with severe injuries (median Injury Severity Score=26). The addition of ketamine did not increase time within RASS goal (53% vs. 54%). At 24 hours after ketamine initiation, the median 24 hour dose increased for fentanyl (2720 mcg vs. 2975 mcg), propofol (3660 mcg vs. 3712 mcg), midazolam (61 mg vs. 331 mg), and dexmedetomidine (1122 mcg vs. 1398 mcg). At 48 hours after ketamine initiation, the 24 hour dose decreased for fentanyl (2975 mcg vs. 2738 mcg), propofol (3712 mcg vs. 3495), midazolam (332 mg vs. 210 mg), and dexmedetomidine (1398 vs. 1380). Among the patients with scheduled or as needed (PRN) opioids, the median 24 hour dose increased at 24 hours (128 mcg vs. 150 mcg) and decreased at 48 hours (150 mcg vs. 132 mcg). Median daily dose of PRN or scheduled benzodiazepines increased at 24 hours (2 mg vs. 3 mg) and 48 hours (3 mg vs. 6 mg). The incidence of positive CAM-ICU scores was similar at 24 and 48 hours post ketamine initiation (4 vs. 3).

Conclusions: The addition of ketamine to a sedation regimen did not increase time within RASS goal, nor decrease total daily dose requirements of other sedative and analgesic medications. Additional research is necessary to determine ketamine’s role as a sedative in the critically ill trauma population.