Ketamine analgo-sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine

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Ketamine analgo-sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine

Amer, Marwa (author): King Faisal Specialist Hosp & Res Ctr, Saudi Arabia; Alfaisal Univ, Saudi Arabia

Moller, Morten Hylander (author): Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark; Res Inst St Joes, Canada

Alshahrani, Mohammed (author): Imam Abdulrahman Bin Faisal Univ, Saudi Arabia

Shehabi, Yahya (author): Monash Univ, Australia; Univ New South Wales, Australia

Arabi, Yaseen M. (author): King Saud Bin Abdulaziz Univ Hlth Sci, Saudi Arabia

Alshamsi, Fayez (author): United Arab Emirates Univ, U Arab Emirates

Sigurosson, Martin Ingi (author): Univ Iceland, Iceland; Landspitali Natl Univ Hosp Iceland, Iceland

Rehn, Marius (author): Oslo Univ Hosp, Norway; Norwegian Air Ambulance Fdn, Norway; Univ Stavanger, Norway

Chew, Michelle (author): Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US

Kalliomaeki, Maija-Liisa (author): Tampere Univ Hosp, Finland

Lewis, Kimberley (author): McMaster Univ, Canada; McMaster Univ, Canada

Al-Suwaidan, Faisal A. (author): Secur Forces Hosp, Saudi Arabia; Minist Hlth, Saudi Arabia; Princess Nourah Bint Abdulrahman Univ, Saudi Arabia; Dar Al Uloom Univ, Saudi Arabia

Al-Dorzi, Hasan M. (author): King Saud Bin Abdulaziz Univ Hlth Sci, Saudi Arabia

Al-Fares, Abdulrahman (author): Al Amiri Hosp, Kuwait; Minist Hlth, Kuwait

Alsadoon, Naif (author): Alshaya Int Trading Co, Saudi Arabia

Bell, Carolyn M. (author): Med Univ South Carolina, SC USA; Med Univ South Carolina, SC USA

Groth, Christine M. (author): Univ Rochester, NY USA

Parke, Rachael (author): Univ Auckland, New Zealand; Auckland City Hosp, New Zealand

Mehta, Sangeeta (author): Mt Sinai Hosp, Canada; Interdept Div Intens Care Med, Canada

Wischmeyer, Paul E. (author): Duke Univ, NC USA

Omeri, Awad (author): Dr Sulaiman Al Habib Med Grp, Saudi Arabia

Olkkola, Klaus T. (author): Univ Helsinki, Finland; Helsinki Univ Hosp, Finland

Alhazzani, Waleed (author): Res Inst St Joes, Canada; McMaster Univ, Canada; King Saud Univ, Saudi Arabia; Jeddah Med Ctr, Saudi Arabia

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2024
2024
English.
In: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576.

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

BackgroundThis Rapid Practice Guideline (RPG) aimed to provide evidence-based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research.MethodsThe RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up-to-date systematic review and meta-analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence-to-decision framework were used to assess the certainty of evidence and to move from evidence to decision/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients' values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities.ResultsData from 17 randomized clinical trials (n = 898) and nine observational studies (n = 1934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo-sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28 days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] -0.05 days; 95% CI -0.07 to -0.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg/kg/h morphine equivalent) (MD -11.6; 95% CI -20.4 to -2.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient-important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied.ConclusionThe RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo-sedation in critically ill adults on iMV when other analgo-sedatives are available; and (2) using ketamine as an adjunct to non-ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non-ketamine usual care sedatives alone. Large-scale trials should provide additional evidence.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Keyword

critical care; GRADE; ketamine; mechanical ventilation; practice guidelines; sedation

Publication and Content Type

ref (subject category)
art (subject category)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Anesthesiology a ...

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