In this episode, I’ll discuss hallucinations from low-dose ketamine use in the ICU.
Low-dose ketamine was recommended in the 2018 PADIS guidelines for the purpose of reducing opioid use in ICU patients. But, this was based on very thin evidence – some systematic reviews in non-ICU patients and a single randomized controlled trial of 93 surgical ICU patients that the panel described as “generally positive”.
Back in episode 957, I discussed A Rapid Practice Guideline on Ketamine Analgo-sedation for Mechanically Ventilated Critically Ill Adults from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine. This guideline changed the recommendation to give equal weight to the option of not using ketamine at all and was based on studies published since the 2018 guidelines that raise doubt about whether routinely using low-dose ketamine in ICU patients is beneficial.
In episode 1002 I discussed an analysis of a small randomized study that showed low-dose ketamine use was significantly associated with frightening and delusional memories of critical illness and ICU treatment in 65% of patients vs only 41% with placebo.
And now in the journal Intensive Care Medicine, a retrospective cohort has been published looking at the association of low-dose ketamine with hallucinations in critically ill patients.
In ICU patients, low-dose ketamine was strongly associated with an increased risk of hallucinations. However, these findings should be interpreted with caution due to the observational nature of the study and the risk of residual confounding.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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