Abstract

Significance: Ketamine provides analgesia and sedation with relative cardiovascular stability and is often used in critically ill patients. SCCM Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption 2018 guidelines conditionally support low-dose continuous infusion only as an opioid-sparing adjunct, with no recommendation for its use as a sedative monotherapy. For acute agitation, ketamine is supported only as intravenous or intramuscular bolus dosing, not continuous infusion. Continuous ketamine infusion use has increased at Baptist Health (BH), with variability in indication selection and dosing.

Purpose: Ketamine prescribing patterns across BH will be evaluated to assess its use with available evidence-based guidelines, review safety outcomes, and identify opportunities for standardization of use and protocol development.

Methods: This is a multi-center, retrospective chart review of adult patients who received continuous ketamine infusion in the intensive care unit (ICU) at BH from July 1, 2024, to August 1, 2025. Pregnant, incarcerated patients and those with status epilepticus were excluded. The primary outcome was to evaluate the percentage of patients with ketamine continuous infusion meeting criteria for appropriate use, defined as: sedation (ketamine infusion used as an adjunct to another sedative), analgosedation (ketamine infusion in combination with an opioid), agitation (ketamine 1–2 mg/kg IV push with a concomitant anxiolytic), and analgesia (ketamine infusion ≤ 0.5 mg/kg/hr with an opioid). Secondary outcomes assessed ketamine’s opioid-sparing effect, delirium incidence, and hemodynamic instability.

Results: In our study, 149 patients were included for analysis. Ketamine was used primarily for sedation (69%), followed by analgosedation (18%), agitation (9%) and analgesia (4%). Sedation (83%) was the indication with the highest observed compliance while the lowest compliance was observed in patients who received ketamine for agitation (0%) and analgesia (50%). The mean ketamine dose was 10 mcg/kg/min over a duration of 2 days. Antipsychotic therapy was required in 34% of patients following ketamine initiation, and 14% required physical restraints. Hypertension necessitating pharmacologic intervention occurred in 29 patients (19%).

Discussion: Overall, ketamine infusion was appropriately used in 78% of patients based on predefined measures of appropriateness. Despite limitations inherent to its retrospective design, these findings identified opportunities to optimize ICU ketamine use particularly for agitation and analgesia in non-mechanically ventilated patients. In response, an analgesia-specific ketamine order set will be implemented in the electronic health record to standardize dosing to ≤ 0.5 mg/kg/hr with concomitant opioid therapy.

Publication Date

Winter 12-8-2026

Presented At:

Midyear Clinical Meeting and Exhibition (ASHP)

Content Type

Poster

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