(948) Cardiovascular Profile of Ketamine Therapy for Depression in ICU Patients

Introduction: Ketamine is used in outpatient psychiatry for its antidepressant benefits. However, there is less literature on its use in critically ill patients in the intensive care unit (ICU). We aimed to describe the cardiovascular profile of subanesthetic doses of intravenous (IV) ketamine when used in an ICU population to treat depression-like symptoms.

Methods: We conducted a retrospective analysis of 3,255 patients who were hospitalized at Mayo Clinic Florida between April 2018 - June 2023 and received IV ketamine. A cohort of 46 adult ICU patients was identified from a larger of 635 IV ketamine recipients. Manual chart review identified patients who had received a subanesthetic dose of IV ketamine (dose range: 0.3 mg/kg - 0.75 mg/kg of body weight) on consecutive days for treatment of depression-like symptoms. An incremental area under the curve (iAUC) was performed for systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) to test for any changes in hemodynamics across the course of treatment. Additionally, paired t-tests were performed for each cardiovascular parameter comparing pre-ketamine treatment vs. post-ketamine infusion at 15, 30, 60, 90 and 120 minutes after each infusion.

Results: Our study included 46 ICU patients predominantly male (60.9%), white (78.3%), and non-Hispanic (89.1%). Of these 46 patients, 28 were immunocompromised i.e., received a solid organ transplant (heart, lung, liver, or kidney). The most common comorbidities seen in our cohort were diabetes (43.5%), essential hypertension (39.1%), and chronic kidney disease (37.0%). The iAUC analysis identified no significant hemodynamic changes after ketamine treatment. The only meaningful change after treatment was observed for the paired t-test between pre-treatment and 30 minutes post-treatment for heart rate. However, this transient increase in heart rate returned to baseline over the next 30 minutes.

Conclusions: The study demonstrates good tolerability of IV ketamine as an intervention to current anti-depression medication in critically ill patients with no significant sustained hemodynamic changes. While our study demonstrated favorable hemodynamic stability, it is imperative to conduct prospective studies to better comprehend the long-term impact of ketamine treatment.