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Annette M Ilg,1 Christine P Beltran,2 Jenny A Shih,3,4 Tuyen T Yankama,5 Margaret M Hayes,6,* Ari L Moskowitz6,7,* 1Division of Emergency Critical Care, Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA; 2Carl J, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 4Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA, USA; 5Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA; 6Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 7Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, New York, NY, USA*These authors contributed equally to this workCorrespondence: Annette M Ilg, Mass General Brigham, Department of Emergency Medicine, Division of Critical Care, 75 Francis St, Boston, MA, 02115, USA, Email ailg@bwh.harvard.eduBackground: Incorporating unfamiliar therapies into practice requires effective longitudinal learning and the optimal way to achieve this is debated. Though not a novel therapy, ketamine in critical care has a paucity of data and variable acceptance, with limited research describing intensivist perceptions and utilization. The Coronavirus-19 pandemic presented a particular crisis where providers rapidly adapted analgosedation strategies to achieve prolonged, deep sedation due to a surge of severe acute respiratory distress syndrome (ARDS).Question: How does clinical experience with ketamine impact the perception and attitude of clinicians toward this therapy?Methods: We conducted a mixed-methods study using quantitative ketamine prescription data and qualitative focus group data. We analyzed prescription patterns of ketamine in a tertiary academic ICU during two different time points: pre-COVID-19 (March 1–June 30, 2019) and during the COVID-19 surge (March 1–June 30, 2020). Two focus groups (FG) of critical care attendings were held, and data were analyzed using the Framework Method for content analysis.Results: Four-hundred forty-six medical ICU patients were mechanically ventilated (195 pre-COVID-19 and 251 during COVID-19). The COVID-19 population was more likely to receive ketamine (81[32.3%] vs 4 [2.1%], p < 0.001). Thirteen respondents participated across two FG sessions (Pre-COVID = 8, Post-COVID=5). The most prevalent attitude among our respondents was discomfort, with three key themes identified as follows: 1) lack of evidence regarding ketamine, 2) lack of personal experience, and 3) desire for more education and protocols.Conclusion: Despite a substantial increase in ketamine prescription during COVID-19, intensivists continued to feel discomfort with utilization. Factors contributing to this discomfort include a lack of evidence, a lack of experience, and a desire for more education and protocols. Increase in experience with ketamine alone was not sufficient to minimize provider discomfort. These findings should inform future curricula and call for process improvement to optimize continuing education.Keywords: analgosedation, continuing education, learning theory, ketamine, critical care |
