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

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.