Low-Dose Ketamine in Chronic Critical Illness

Area of Science:

• Critical Care Medicine
• Pharmacology
• Neuroscience

Background:

• Prolonged critical illness presents complex challenges, including agitation, pain, and psychological distress.
• Management often requires high doses of sedatives and analgesics, with potential for adverse effects.
• Exploring alternative pharmacotherapies is crucial for optimizing patient care.

Observation:

• A case series involving four critically ill patients receiving low-dose ketamine infusions (0.5–4 μg/kg/min).
• Ketamine was administered for various indications, including agitation, depression, anxiety, mechanical ventilation liberation, and palliation.
• Observed effects were documented across diverse clinical scenarios.

Findings:

• Ketamine infusion reduced agitation in a patient dependent on high-dose sedatives and analgesics.
• Improvements in depression and anxiety symptoms were noted in one patient.
• Potential facilitation of liberation from mechanical ventilation and palliation of lethargy were observed.

Implications:

• Low-dose ketamine may be a valuable adjunct in managing agitation and pain in critically ill patients.
• It shows promise for addressing psychological symptoms like depression and anxiety.
• Further research is warranted to confirm ketamine's role in opioid/benzodiazepine withdrawal and respiratory depression prevention.