Inconsistencies in ketamine use seen among practitioners

A recent study has found inconsistencies in the use of ketamine, particularly in terms of dose, duration, and reasons to avoid or limit this medication. This is the case despite many critical care practitioners reporting being comfortable in using ketamine.

Members of the Society of Critical Care Medicine (SCCM) Clinical Pharmacy and Pharmacology Section developed an online survey, which was distributed to physician, pharmacist, nurse practitioner, physician assistant, and nurse members of SCCM.

The survey asked SCCM members about self-reported practices regarding ketamine use and potential barriers in acute and critically ill patients.

Majority of the 341 respondents were adult physicians practicing in the US at academic medical centres. Clinicians reported being comfortable or very comfortable using ketamine to facilitate intubation (80.0 percent), for analgesia (77.9 percent), procedural sedation (79.4 percent), continuous intensive care unit sedation (65.8 percent), dressing changes (62.4 percent), or for asthma exacerbation (58.8 percent) and status epilepticus (40.4 percent).

Clinicians said they were least comfortable with ketamine use for alcohol withdrawal (24.7 percent) and opioid detoxification (23.2 percent). Most respondents also reported “never” or “infrequently using ketamine preferentially for continuous intravenous analgesia (55.6 percent) or sedation (61 percent).

Of note, responses regarding dosing ranges and duration were mixed. Common barriers to ketamine use included adverse effects (42.6 percent), other practitioners not routinely using the medication (41.5 percent), lack of evidence (33.5 percent), lack of familiarity (33.1 percent), and hospital/institutional policy guiding the indication for use (32.3 percent).

“Further educational tools may be targeted at practitioners to improve appropriate ketamine use,” the investigators said.