Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract:
Mechanically ventilated, critically ill patients often require analgesic and sedative medications. A number of different options are available for continuous analgosedation in this patient population however each medication has its own advantages and limitations.

Ketamine was first synthesized in 1962 with initial use as an anesthetic agent. Since then, ketamine has been used for many indications including continuous analgosedation in critically ill patients. There is, however, a paucity of evidence surrounding the use of ketamine in this setting.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe the pharmacology of ketamine.
• Evaluate advantages and limitations of the use of ketamine in the ICU.
• Discuss the  available evidence for the use of ketamine as a continuous analogsedation agent  in the ICU.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.. The assigned universal program number(s) is JA4008223-0000-23-077-H01-P. .  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit

Suggested Additional Reading:

1. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263-306.
2. Buchheit JL, Yeh DD, Eikermann M, Lin H. Impact of Low-Dose Ketamine on the Usage of Continuous Opioid Infusion for the Treatment of Pain in Adult Mechanically Ventilated Patients in Surgical Intensive Care Units. Journal of Intensive Care Medicine. 2017;34(8):646–51.
3. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine. 2018;46(9).
4. Frölich MA, Arabshahi A, Katholi C, Prasain J, Barnes S. Hemodynamic characteristics of midazolam, propofol, and dexmedetomidine in healthy volunteers. J Clin Anesth. 2011 May;23(3):218-23.
5. Garber PM, Droege CA, Carter KE, Harger NJ, Mueller EW. Continuous Infusion Ketamine for Adjunctive Analgosedation in Mechanically Ventilated, Critically Ill Patients. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2019;39(3):288–96.
6. Groetzinger LM, Rivosecchi RM, Bain W, Bahr M, Chin K, Mcverry BJ, et al. Ketamine Infusion for Adjunct Sedation in Mechanically Ventilated Adults. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2018;38(2):181–8.
7. Hughes CG, McGrane S, Pandharipande PP. Sedation in the intensive care setting. Clin Pharmacol. 2012;4:53-63.
8. Jaeger M, Attridge RL, Neff LA, Gutierrez GC. Safety and Effectiveness of Sedation With Adjunctive Ketamine Versus Nonketamine Sedation in the Medical Intensive Care Unit. Journal of Pharmacy Practice. 2020;:089719002092593.
9. Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res. 2014 Sep-Dec;8(3):283-90.
10. andharipande P, Hughes, Mcgrane. Sedation in the intensive care setting. Clinical Pharmacology: Advances and Applications. 2012;:53.
11. Perbet S, Verdonk F, Godet T, Jabaudon M, Chartier C, Cayot S, et al. Low doses of ketamine reduce delirium but not opiate consumption in mechanically ventilated and sedated ICU patients: A randomised double-blind control trial. Anaesthesia Critical Care & Pain Medicine. 2018;37(6):589–95.
12. Perumal D, Selvaraj N, Adhimoolam M, Lazarus S, Mohammed MR. Midazolam premedication for Ketamine-induced emergence phenomenon: A prospective observational study. Journal of Research in Pharmacy Practice. 2015;4(2):89.