Ketamine in Critically Ill Patients: Use, Perceptions, and Potential Barriers.

Autor:	Bell CM; Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA., Rech MA; Department of Pharmacy, Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA., Akuamoah-Boateng KA; Department of Surgery: Division of Acute Care Surgical Services, Virginia Commonwealth University Medical Center, Richmond, VA, USA., Kasotakis G; Department of Surgery, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA., McMurray JD; Department of Anesthesia, Medical University of South Carolina, Charleston, SC, USA., Moses BA; Department of Anesthesia: Division of Critical Care, University of Virginia Health, Charlottesville, VA, USA., Mueller SW; Department of Pharmacy, University of Colorado Health, Aurora, CO, USA., Patel GP; Department of Pharmacy, University of Chicago Medical Center, Chicago, IL, USA., Roberts RJ; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA., Sakhuja A; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA., Salvator A; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA., Setliff EL; Department of Clinical Education Services, Atrium Health Cabarrus, Concord, NC, USA., Droege CA; Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA.
Jazyk:	angličtina
Zdroj:	Journal of pharmacy practice [J Pharm Pract] 2024 Apr; Vol. 37 (2), pp. 351-363. Date of Electronic Publication: 2022 Oct 25.
DOI:	10.1177/08971900221134551
Abstrakt:	Objective: To evaluate practitioner use of ketamine and identify potential barriers to use in acutely and critically ill patients. To compare characteristics, beliefs, and practices of ketamine frequent users and non-users. Methods: An online survey developed by members of the Society of Critical Care Medicine (SCCM) Clinical Pharmacy and Pharmacology Section was distributed to physician, pharmacist, nurse practitioner, physician assistant and nurse members of SCCM. The online survey queried SCCM members on self-reported practices regarding ketamine use and potential barriers in acute and critically ill patients. Results: Respondents, 341 analyzed, were mostly adult physicians, practicing in the United States at academic medical centers. Clinicians were comfortable or very comfortable using ketamine to facilitate intubation (80.0%), for analgesia (77.9%), procedural sedation (79.4%), continuous ICU sedation (65.8%), dressing changes (62.4%), or for asthma exacerbation and status epilepticus (58.8% and 40.4%). Clinicians were least comfortable with ketamine use for alcohol withdrawal and opioid detoxification (24.7% and 23.2%). Most respondents reported "never" or "infrequently" using ketamine preferentially for continuous IV analgesia (55.6%) or sedation (61%). Responses were mixed across dosing ranges and duration. The most common barriers to ketamine use were adverse effects (42.6%), other practitioners not routinely using the medication (41.5%), lack of evidence (33.5%), lack of familiarity (33.1%), and hospital/institutional policy guiding the indication for use (32.3%). Conclusion: Although most critical care practitioners report feeling comfortable using ketamine, there are many inconsistencies in practice regarding dose, duration, and reasons to avoid or limit ketamine use. Further educational tools may be targeted at practitioners to improve appropriate ketamine use. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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