(1026) Ketamine Infusion for Analgosedation in Mechanically Ventilated Trauma Patients

Introduction: The guidelines for sedation and delirium recommends light sedation in mechanically ventilated patients with nonbenzodiazepine sedatives. Propofol is frequently used in mechanically ventilated trauma patients due to its rapid onset and offset. Trauma patients are a unique subset of patients that may require additional considerations when selecting sedative agents, as trauma is an independent risk factor for pain and delirium. Ketamine rapidly induces dissociative sedation but also is an opioid receptor agonist and may help treat pain. The aim of this study is to evaluate analgosedative outcomes with the addition of continuous infusion ketamine in mechanically ventilated trauma patients.

Methods: This multicenter, retrospective, self-control case series evaluated the impact of ketamine on analgosedative outcomes in mechanically ventilated adult trauma patients between 3/1/2020 and 11/30/2022. The primary endpoint was the difference between the highest IV propofol dose charted within 3 hours before ketamine initiation and the lowest dose charted within 24 hours after ketamine initiation. Secondary endpoints included proportion of time at goal Richmond Agitation Sedation Scale (RASS), delirium free days, coma free days, change in IV morphine milligram equivalents (MME) received, and proportion of time at goal Critical Care Pain Observation Tool (CPOT).

Results: A total of 32 patients were included in this analysis. The patient population had a mean ICU length of stay of 14.9 days and a mean injury severity score on admission of 21.9. The initiation of ketamine was associated with a median decrease in propofol used of -20 µg/kg/min (IQR -30 to -11.3; P < 0.0001). The median difference in IV MME was 0 (IQR -6.9 to 8.8; P < 0.92). Other secondary outcomes included median percent time at goal RASS (66.7% [IQR 33.3 to 100] vs. 79.2% [IQR 55.2 to 87.5] post-ketamine initiation), median percent time at goal CPOT (100% [IQR 66.7 to 100] vs. 85.4% [IQR 64.6 to 99] respectively), median delirium free days (6 days [IQR 2 to 11]), and median coma free days (14 [IQR 13 to 14]).

Conclusions: The addition of ketamine was not associated with decreased opioid use, but it resulted in a clinically significant reduction in concomitant sedative use while achieving similar proportions of time at goal RASS scores.