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Ketamine sedation in the intensive care unit: a survey of Canadian intensivists

Sédation à la kétamine aux soins intensifs : un sondage auprès des intensivistes du Canada

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Abstract

Purpose

We sought to understand the beliefs and practices of Canadian intensivists regarding their use of ketamine as a sedative in critically ill patients and to gauge their interest in a randomized controlled trial (RCT) examining its use in the intensive care unit (ICU).

Methods

We designed and validated an electronic self-administered survey examining the use of ketamine as a sedative infusion for ICU patients. We surveyed 400 physician members of the Canadian Critical Care Society (CCCS) via email between February and April 2022 and sent three reminders at two-week intervals. The survey was redistributed in January 2023 to improve the response rate.

Results

We received 87/400 (22%) completed questionnaires. Most respondents reported they rarely use ketamine as a continuous infusion for sedation or analgesia in the ICU (52/87, 58%). Physicians reported the following conditions would make them more likely to use ketamine: asthma exacerbation (73/87, 82%), tolerance to opioids (68/87, 77%), status epilepticus (44/87, 50%), and severe acute respiratory distress syndrome (33/87, 38%). Concern for side-effects that limited respondents’ use of ketamine include adverse psychotropic effects (61/87, 69%) and delirium (47/87, 53%). The majority of respondents agreed there is need for an RCT to evaluate ketamine as a sedative infusion in the ICU (62/87, 71%).

Conclusion

This survey of Canadian intensivists illustrates that use of ketamine as a continuous infusion for sedation is limited, and is at least partly driven by concerns of adverse psychotropic effects. Canadian physicians endorse the need for a trial investigating the safety and efficacy of ketamine as a sedative for critically ill patients.

Résumé

Objectif

Nous avons cherché à comprendre les croyances et les pratiques des intensivistes pratiquant au Canada concernant leur utilisation de la kétamine comme sédatif chez la patientèle gravement malade et à évaluer leur intérêt pour une étude randomisée contrôlée (ERC) examinant son utilisation à l’unité de soins intensifs (USI).

Méthode

Nous avons mis au point et validé un sondage électronique auto-administré examinant l’utilisation de la kétamine comme perfusion sédative pour les patient·es aux soins intensifs. Nous avons envoyé le sondage à 400 médecins membres de la Société canadienne de soins intensifs (SCCC) par courriel entre février et avril 2022 et envoyé trois rappels à intervalles de deux semaines. Le sondage a été redistribué en janvier 2023 afin d’améliorer le taux de réponse.

Résultats

Nous avons reçu 87 questionnaires remplis sur 400 (22 %). La plupart des personnes répondantes ont déclaré qu’elles utilisaient rarement la kétamine en perfusion continue pour la sédation ou l’analgésie à l’USI (52/87, 58 %). Les médecins ont déclaré que les conditions suivantes les rendraient plus susceptibles d’utiliser de la kétamine : une exacerbation de l’asthme (73/87, 82 %), une tolérance aux opioïdes (68/87, 77 %), un état de mal épileptique (44/87, 50 %) et un syndrome de détresse respiratoire aigu (33/87, 38 %). Les inquiétudes quant aux effets secondaires qui ont limité l’utilisation de la kétamine par les répondant·es comprennent les effets psychotropes indésirables (61/87, 69 %) et le delirium (47/87, 53 %). La majorité des personnes répondantes étaient d’accord qu’une ERC est nécessaire pour évaluer la kétamine en tant que perfusion sédative à l’USI (62/87, 71 %).

Conclusion

Cette enquête menée auprès d’intensivistes au Canada montre que l’utilisation de la kétamine comme perfusion continue pour la sédation est limitée, au moins en partie en raison d’inquiétudes liées aux effets psychotropes indésirables. Les médecins pratiquant au Canada reconnaissent la nécessité d’une étude sur l’innocuité et l’efficacité de la kétamine comme sédatif pour la patientèle gravement malade.

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Author contributions

Bram Rochwerg and Sameer Sharif designed the study, analyzed the results, and drafted the initial manuscript. Laveena Munshi, Lisa Burry, Sara Gray, Dipayan Chaudhuri, Sangeeta Mehta, Mark Duffett, and Reed A. Siemieniuk all equally contributed in editing the contents of the manuscript.

Acknowledgement

We would like to thank the CCCS members for their help with disseminating the survey. We would also like to thank all the CCCS members who responded to the survey.

Disclosures

None.

Funding statement

Dr. Sameer Sharif holds a McMaster University Department of Medicine Internal Career Research Award.

Editorial responsibility

This submission was handled by Dr. Alexis F. Turgeon, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada

    Sameer Sharif MD, MSc

  2. Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada

    Sameer Sharif MD, MSc, Dipayan Chaudhuri MD, MSc & Bram Rochwerg MD, MSc

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Sameer Sharif MD, MSc, Dipayan Chaudhuri MD, MSc, Mark Duffett PhD, Reed A. Siemieniuk MD, PhD & Bram Rochwerg MD, MSc

  4. Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada

    Laveena Munshi MD, MSc, Lisa Burry PharmD & Sangeeta Mehta MD

  5. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Lisa Burry PharmD

  6. Division of Emergency Medicine, and the Interdepartmental Division of Critical Care Medicine, Department of Medicine, Unity Health Network, University of Toronto, Toronto, ON, Canada

    Sara Gray MD

  7. Hamilton General Hospital, 237 Barton St East, 2nd Floor McMaster Wing, Room 252, Hamilton, ON, L8L 2X2, Canada

    Sameer Sharif MD, MSc

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  1. Sameer Sharif MD, MSc
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Correspondence to Sameer Sharif MD, MSc.

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Sharif, S., Munshi, L., Burry, L. et al. Ketamine sedation in the intensive care unit: a survey of Canadian intensivists. Can J Anesth/J Can Anesth 71, 118–126 (2024). https://doi.org/10.1007/s12630-023-02608-x

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