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Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)
Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs). Multicenter, retrospective, observational study in children
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| Published in: | Critical care research and practice 2024-07, Vol.2024 (1), p.6626899 |
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| container_title | Critical care research and practice |
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| creator | Groth, Christine M Droege, Christopher A Sarangarm, Preeyaporn Cucci, Michaelia D Gustafson, Kyle A Connor, Kathryn A Kaukeinen, Kimberly Acquisto, Nicole M Chui, Sai Ho J Dixit, Deepali Flannery, Alexander H Glass, Nina E Horng, Helen Heavner, Mojdeh S Kinney, Justin Peppard, William J Sikora, Andrea Erstad, Brian L |
| description | Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs).
Multicenter, retrospective, observational study in children |
| doi_str_mv | 10.1155/2024/6626899 |
| format | article |
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Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI. Adverse effects were collected over the first 7 days of CI ketamine.
Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (
= 13), 92% intubated (
= 22), 25% on CI vasopressors (
= 6), and 33% on CI paralytics (
= 8). Ketamine indications were analgesia/sedation (
= 21, 87.5%) and status epilepticus (
= 3, 12.5%). Median starting dose was 0.5 (0.48-0.70) mg/kg/hr and continued for a median of 2.4 (1.3-4.4) days. There was a significant difference in mean proportion of time spent within goal pain score range (24H prior: 74% ± 14%, 0-24H: 85% ± 10%, and 25-48H: 72% ± 20%;
=0.014). A significant reduction in median morphine milligram equivalents (MME) was seen (24H prior: 58 (8-195) mg vs. 0-24H: 4 (0-69) mg and
=0.01), but this was not sustained (25-48H: 24 (2-246) mg and
=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%).
Ketamine CI improved time in goal pain score range and significantly reduced MME, but this was not sustained. Larger prospective studies are needed in the pediatric population.</description><identifier>ISSN: 2090-1305</identifier><identifier>EISSN: 2090-1313</identifier><identifier>DOI: 10.1155/2024/6626899</identifier><identifier>PMID: 39104664</identifier><language>eng</language><publisher>Egypt: John Wiley & Sons, Inc</publisher><subject>Comparative analysis ; Dexmedetomidine ; Epilepsy ; Ketamine ; Pediatric intensive care ; Tachycardia</subject><ispartof>Critical care research and practice, 2024-07, Vol.2024 (1), p.6626899</ispartof><rights>Copyright © 2024 Christine M. Groth et al.</rights><rights>COPYRIGHT 2024 John Wiley & Sons, Inc.</rights><rights>Copyright © 2024 Christine M. Groth et al. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c436t-ff5611729572070089b1e3ea8d232328e93d1960923c7501b343ccb0ec44f5133</cites><orcidid>0000-0003-0407-8481 ; 0000-0002-5823-7495 ; 0000-0003-1622-7990 ; 0000-0003-2020-0571 ; 0000-0002-8355-5217 ; 0000-0003-3007-7685 ; 0000-0002-7649-9624 ; 0000-0003-2933-1594 ; 0000-0003-4333-373X ; 0000-0001-8909-9921 ; 0000-0002-3755-5435 ; 0000-0002-7780-5144 ; 0000-0002-6821-4289 ; 0000-0002-7609-8855 ; 0000-0001-7419-5312 ; 0000-0001-7960-0161 ; 0000-0002-1550-6827</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300064/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300064/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39104664$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Groth, Christine M</creatorcontrib><creatorcontrib>Droege, Christopher A</creatorcontrib><creatorcontrib>Sarangarm, Preeyaporn</creatorcontrib><creatorcontrib>Cucci, Michaelia D</creatorcontrib><creatorcontrib>Gustafson, Kyle A</creatorcontrib><creatorcontrib>Connor, Kathryn A</creatorcontrib><creatorcontrib>Kaukeinen, Kimberly</creatorcontrib><creatorcontrib>Acquisto, Nicole M</creatorcontrib><creatorcontrib>Chui, Sai Ho J</creatorcontrib><creatorcontrib>Dixit, Deepali</creatorcontrib><creatorcontrib>Flannery, Alexander H</creatorcontrib><creatorcontrib>Glass, Nina E</creatorcontrib><creatorcontrib>Horng, Helen</creatorcontrib><creatorcontrib>Heavner, Mojdeh S</creatorcontrib><creatorcontrib>Kinney, Justin</creatorcontrib><creatorcontrib>Peppard, William J</creatorcontrib><creatorcontrib>Sikora, Andrea</creatorcontrib><creatorcontrib>Erstad, Brian L</creatorcontrib><title>Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)</title><title>Critical care research and practice</title><addtitle>Crit Care Res Pract</addtitle><description>Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs).
Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI. Adverse effects were collected over the first 7 days of CI ketamine.
Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (
= 13), 92% intubated (
= 22), 25% on CI vasopressors (
= 6), and 33% on CI paralytics (
= 8). Ketamine indications were analgesia/sedation (
= 21, 87.5%) and status epilepticus (
= 3, 12.5%). Median starting dose was 0.5 (0.48-0.70) mg/kg/hr and continued for a median of 2.4 (1.3-4.4) days. There was a significant difference in mean proportion of time spent within goal pain score range (24H prior: 74% ± 14%, 0-24H: 85% ± 10%, and 25-48H: 72% ± 20%;
=0.014). A significant reduction in median morphine milligram equivalents (MME) was seen (24H prior: 58 (8-195) mg vs. 0-24H: 4 (0-69) mg and
=0.01), but this was not sustained (25-48H: 24 (2-246) mg and
=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%).
Ketamine CI improved time in goal pain score range and significantly reduced MME, but this was not sustained. Larger prospective studies are needed in the pediatric population.</description><subject>Comparative analysis</subject><subject>Dexmedetomidine</subject><subject>Epilepsy</subject><subject>Ketamine</subject><subject>Pediatric intensive care</subject><subject>Tachycardia</subject><issn>2090-1305</issn><issn>2090-1313</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNptkl1r2zAUhs3YWEvXu10Pw2B0MLc6lixbV6OEfYR1rGzLtZDlo0TFsVJJzui_n7ykoYHpXOjrOS86R2-WvQZyCVBVVyUp2RXnJW-EeJadlkSQAijQ54c1qU6y8xDuSBpU0Iqzl9kJFUAY5-w0W30f-2g1DhF9_hOjd2GDOtotpt3W4p_cmfwbRrW2A-aLgLkd8lvsrIre6nye8oYw0TPl0_1gY8gvHvnidj5b5L_i2D28f5W9MKoPeL6fz7LF50-_Z1-Lmx9f5rPrm0IzymNhTMUB6lJUdUlqQhrRAlJUTVfSFA0K2oHgRJRU1xWBljKqdUtQM2YqoPQsm-90O6fu5MbbtfIP0ikr_x04v5TKp4p7lKkZBoShKZEwhFbVteGkMdApELqEpPVxp7UZ2zV2U5e86o9Ej28Gu5JLt5WQ-k4IZ0nhYq_g3f2IIcq1DRr7Xg3oxiBpKrAC1kCV0Lc7dKnS2-xgXJLUEy6vG0Lr9MWUJOryP1SKDtdWuwGNTedHCe-eJKxQ9XEVXD9G64ZwDH7YgTp5IHg0hzqByMlscjKb3Jst4W-e9uYAP1qL_gUIxcqq</recordid><startdate>20240727</startdate><enddate>20240727</enddate><creator>Groth, Christine M</creator><creator>Droege, Christopher A</creator><creator>Sarangarm, Preeyaporn</creator><creator>Cucci, Michaelia D</creator><creator>Gustafson, Kyle A</creator><creator>Connor, Kathryn A</creator><creator>Kaukeinen, Kimberly</creator><creator>Acquisto, Nicole M</creator><creator>Chui, Sai Ho J</creator><creator>Dixit, Deepali</creator><creator>Flannery, Alexander H</creator><creator>Glass, Nina E</creator><creator>Horng, Helen</creator><creator>Heavner, Mojdeh S</creator><creator>Kinney, Justin</creator><creator>Peppard, William J</creator><creator>Sikora, Andrea</creator><creator>Erstad, Brian L</creator><general>John Wiley & Sons, Inc</general><general>Wiley</general><general>Hindawi Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-0407-8481</orcidid><orcidid>https://orcid.org/0000-0002-5823-7495</orcidid><orcidid>https://orcid.org/0000-0003-1622-7990</orcidid><orcidid>https://orcid.org/0000-0003-2020-0571</orcidid><orcidid>https://orcid.org/0000-0002-8355-5217</orcidid><orcidid>https://orcid.org/0000-0003-3007-7685</orcidid><orcidid>https://orcid.org/0000-0002-7649-9624</orcidid><orcidid>https://orcid.org/0000-0003-2933-1594</orcidid><orcidid>https://orcid.org/0000-0003-4333-373X</orcidid><orcidid>https://orcid.org/0000-0001-8909-9921</orcidid><orcidid>https://orcid.org/0000-0002-3755-5435</orcidid><orcidid>https://orcid.org/0000-0002-7780-5144</orcidid><orcidid>https://orcid.org/0000-0002-6821-4289</orcidid><orcidid>https://orcid.org/0000-0002-7609-8855</orcidid><orcidid>https://orcid.org/0000-0001-7419-5312</orcidid><orcidid>https://orcid.org/0000-0001-7960-0161</orcidid><orcidid>https://orcid.org/0000-0002-1550-6827</orcidid></search><sort><creationdate>20240727</creationdate><title>Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)</title><author>Groth, Christine M ; Droege, Christopher A ; Sarangarm, Preeyaporn ; Cucci, Michaelia D ; Gustafson, Kyle A ; Connor, Kathryn A ; Kaukeinen, Kimberly ; Acquisto, Nicole M ; Chui, Sai Ho J ; Dixit, Deepali ; Flannery, Alexander H ; Glass, Nina E ; Horng, Helen ; Heavner, Mojdeh S ; Kinney, Justin ; Peppard, William J ; Sikora, Andrea ; Erstad, Brian L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-ff5611729572070089b1e3ea8d232328e93d1960923c7501b343ccb0ec44f5133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Comparative analysis</topic><topic>Dexmedetomidine</topic><topic>Epilepsy</topic><topic>Ketamine</topic><topic>Pediatric intensive care</topic><topic>Tachycardia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Groth, Christine M</creatorcontrib><creatorcontrib>Droege, Christopher A</creatorcontrib><creatorcontrib>Sarangarm, Preeyaporn</creatorcontrib><creatorcontrib>Cucci, Michaelia D</creatorcontrib><creatorcontrib>Gustafson, Kyle A</creatorcontrib><creatorcontrib>Connor, Kathryn A</creatorcontrib><creatorcontrib>Kaukeinen, Kimberly</creatorcontrib><creatorcontrib>Acquisto, Nicole M</creatorcontrib><creatorcontrib>Chui, Sai Ho J</creatorcontrib><creatorcontrib>Dixit, Deepali</creatorcontrib><creatorcontrib>Flannery, Alexander H</creatorcontrib><creatorcontrib>Glass, Nina E</creatorcontrib><creatorcontrib>Horng, Helen</creatorcontrib><creatorcontrib>Heavner, Mojdeh S</creatorcontrib><creatorcontrib>Kinney, Justin</creatorcontrib><creatorcontrib>Peppard, William J</creatorcontrib><creatorcontrib>Sikora, Andrea</creatorcontrib><creatorcontrib>Erstad, Brian L</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Critical care research and practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Groth, Christine M</au><au>Droege, Christopher A</au><au>Sarangarm, Preeyaporn</au><au>Cucci, Michaelia D</au><au>Gustafson, Kyle A</au><au>Connor, Kathryn A</au><au>Kaukeinen, Kimberly</au><au>Acquisto, Nicole M</au><au>Chui, Sai Ho J</au><au>Dixit, Deepali</au><au>Flannery, Alexander H</au><au>Glass, Nina E</au><au>Horng, Helen</au><au>Heavner, Mojdeh S</au><au>Kinney, Justin</au><au>Peppard, William J</au><au>Sikora, Andrea</au><au>Erstad, Brian L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)</atitle><jtitle>Critical care research and practice</jtitle><addtitle>Crit Care Res Pract</addtitle><date>2024-07-27</date><risdate>2024</risdate><volume>2024</volume><issue>1</issue><spage>6626899</spage><pages>6626899-</pages><issn>2090-1305</issn><eissn>2090-1313</eissn><abstract>Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs).
Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI. Adverse effects were collected over the first 7 days of CI ketamine.
Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (
= 13), 92% intubated (
= 22), 25% on CI vasopressors (
= 6), and 33% on CI paralytics (
= 8). Ketamine indications were analgesia/sedation (
= 21, 87.5%) and status epilepticus (
= 3, 12.5%). Median starting dose was 0.5 (0.48-0.70) mg/kg/hr and continued for a median of 2.4 (1.3-4.4) days. There was a significant difference in mean proportion of time spent within goal pain score range (24H prior: 74% ± 14%, 0-24H: 85% ± 10%, and 25-48H: 72% ± 20%;
=0.014). A significant reduction in median morphine milligram equivalents (MME) was seen (24H prior: 58 (8-195) mg vs. 0-24H: 4 (0-69) mg and
=0.01), but this was not sustained (25-48H: 24 (2-246) mg and
=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%).
Ketamine CI improved time in goal pain score range and significantly reduced MME, but this was not sustained. Larger prospective studies are needed in the pediatric population.</abstract><cop>Egypt</cop><pub>John Wiley & Sons, Inc</pub><pmid>39104664</pmid><doi>10.1155/2024/6626899</doi><orcidid>https://orcid.org/0000-0003-0407-8481</orcidid><orcidid>https://orcid.org/0000-0002-5823-7495</orcidid><orcidid>https://orcid.org/0000-0003-1622-7990</orcidid><orcidid>https://orcid.org/0000-0003-2020-0571</orcidid><orcidid>https://orcid.org/0000-0002-8355-5217</orcidid><orcidid>https://orcid.org/0000-0003-3007-7685</orcidid><orcidid>https://orcid.org/0000-0002-7649-9624</orcidid><orcidid>https://orcid.org/0000-0003-2933-1594</orcidid><orcidid>https://orcid.org/0000-0003-4333-373X</orcidid><orcidid>https://orcid.org/0000-0001-8909-9921</orcidid><orcidid>https://orcid.org/0000-0002-3755-5435</orcidid><orcidid>https://orcid.org/0000-0002-7780-5144</orcidid><orcidid>https://orcid.org/0000-0002-6821-4289</orcidid><orcidid>https://orcid.org/0000-0002-7609-8855</orcidid><orcidid>https://orcid.org/0000-0001-7419-5312</orcidid><orcidid>https://orcid.org/0000-0001-7960-0161</orcidid><orcidid>https://orcid.org/0000-0002-1550-6827</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2090-1305 |
| ispartof | Critical care research and practice, 2024-07, Vol.2024 (1), p.6626899 |
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| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_356f19f34f504e1ba77f608f1da19c21 |
| source | Open Access: Wiley-Blackwell Open Access Journals; PubMed Central |
| subjects | Comparative analysis Dexmedetomidine Epilepsy Ketamine Pediatric intensive care Tachycardia |
| title | Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study) |
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