Impact of ketamine on dynamic compliance and airway resistance of sedated and mechanically ventilated ICU patients

Introduction

Little is known about the potential hemodynamic benefits of continuous ketamine sedation and analgesia in adult ICU patients.

Methods

In a pilot multicenter, prospective, double-blind, randomized control trial, we screened 66 adult ICU patients who required sedation and analgesia. Patients meeting entry criteria were randomized to continuous infusion of ketamine (study) or fentanyl (control) for >24 hours to achieve a Ramsay Sedation Scale of 4. We recorded lung compliance and airway resistance. Sixty percent of patients (3/5) received ketamine with low-dose midazolam for 24 hours followed by midazolam only and 40% (2/5) received fentanyl. We measured dynamic compliance and airway resistance for both groups before sedative infusion and every 4 hours thereafter.

Results

There was a statistically significant increase in the dynamic compliance in the study group compared with the control group (P < 0.05). There was a statistically significant decrease in the airway resistance in the study group compared with the control group (Figure 1).

Figure 1

(abstract P404)

Conclusion

This preliminary report illustrates the possible value of ketamine for continuous ICU sedation and analgesia.