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Experiential Learning with Ketamine: A Mixed-Methods Exploratory Study on Prescription and Perception.

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Despite increased ketamine use during COVID-19, intensivists remain uncomfortable. Lack of evidence, experience, and education contribute to this discomfort, highlighting the need for improved training and protocols for ketamine in critical care.

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Area of Science:

  • Critical care medicine
  • Pharmacology
  • Medical education

Background:

  • Ketamine use in critical care is debated due to limited data and variable acceptance.
  • The COVID-19 pandemic necessitated rapid adaptation of sedation strategies, including analgosedation for severe acute respiratory distress syndrome (ARDS).

Purpose of the Study:

  • To investigate how clinical experience with ketamine impacts intensivist perceptions and attitudes.
  • To analyze ketamine prescription patterns before and during the COVID-19 surge.

Main Methods:

  • Mixed-methods study combining quantitative ketamine prescription data and qualitative focus group data.
  • Analysis of prescription patterns in a tertiary academic ICU during pre-COVID-19 (2019) and COVID-19 surge (2020) periods.
  • Two focus groups with critical care attendings analyzed using the Framework Method.

Main Results:

  • Ketamine prescription increased significantly during COVID-19 (32.3%) compared to pre-COVID-19 (2.1%).
  • Despite increased use, intensivists reported discomfort, citing lack of evidence, personal experience, and need for education/protocols.
  • Thirteen critical care attendings participated in focus groups (8 pre-COVID, 5 post-COVID).

Conclusions:

  • Increased ketamine prescription during COVID-19 did not reduce intensivist discomfort.
  • Key factors contributing to discomfort include limited evidence, insufficient personal experience, and a desire for enhanced education and standardized protocols.
  • Findings emphasize the need for improved critical care curricula and process improvements for continuing education on ketamine utilization.