Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)

Christine M. Groth; Christopher A. Droege; Preeyaporn Sarangarm; Michaelia D. Cucci; Kyle A. Gustafson; Kathryn A. Connor; Kimberly Kaukeinen; Nicole M. Acquisto; Sai Ho J. Chui; Deepali Dixit; Alexander H. Flannery; Nina E. Glass; Helen Horng; Mojdeh S. Heavner; Justin Kinney; William J. Peppard; Andrea Sikora; Brian L. Erstad

doi:10.1155/2024/6626899

Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)

Christine M. Groth, Christopher A. Droege, Preeyaporn Sarangarm, Michaelia D. Cucci, Kyle A. Gustafson, Kathryn A. Connor, Kimberly Kaukeinen, Nicole M. Acquisto, Sai Ho J. Chui, Deepali Dixit, Alexander H. Flannery, Nina E. Glass, Helen Horng, Mojdeh S. Heavner, Justin Kinney, William J. Peppard, Andrea Sikora, Brian L. Erstad

Research output: Contribution to journal › Article › peer-review

Abstract

Objective. 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). Methods. 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. Results. Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (n = 13), 92% intubated (n = 22), 25% on CI vasopressors (n = 6), and 33% on CI paralytics (n = 8). Ketamine indications were analgesia/sedation (n = 21, 87.5%) and status epilepticus (n = 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%; p=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 p=0.01), but this was not sustained (25-48H: 24 (2-246) mg and p=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%). Conclusions. 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.

Original language	English
Article number	6626899
Journal	Critical Care Research and Practice
Volume	2024
DOIs	https://doi.org/10.1155/2024/6626899
State	Published - 2024

Bibliographical note

Publisher Copyright:
© 2024 Christine M. Groth et al.

Funding

We would like to thank the following individuals for their participation on the Ketamine-ICU Study Group: Allegheny General Hospital: Laura Brickett; Catholic Medical Center: Russell Bardsley, PharmD, BCPS; MacNeal Hospital: Erica M. Fernandez, PharmD BCPS, BCCCP; Nationwide Children's Hospital: Amber Brax, PharmD, BCPS; Nova Southeastern University College of Pharmacy: Nicole Ianniello, Pharm.D.; Texas Tech University: Young Ran Lee, PharmD, BCPS, BCCCP; University of Florida Health Jacksonville: Michael Erdman, PharmD, BCPS; University of North Texas System College of Pharmacy: Kassie PIuger, PharmD; University of Oklahoma Medical Center: Janice Tsui, PharmD, BCPS. We would like to acknowledge the following people for their participation in the data collection: Parkview Regional Medical Center: Kassandra A. Foellinger, PharmD, BCPS; Luke C. Keller, PharmD, BCPS, BCCCP; Dustin Lin, PharmD, BCPS, BCCCP; Michael E. Todt, PharmD, BCCCP; Stacy Waterman, PharmD, BCPS; Texas Health Harris Methodist Fort Worth: Kristi Carter, PharmD, BCPS, BCCCP; Tania Joakim, PharmD; Kira Monaco, PharmD; University of Rochester Medical Center: Samantha Delibert, PharmD, BCCCP; Mercy Hoang-Nguyen, PharmD; Kaylee Maynard, PharmD; Faisal Minhaj, PharmD; Stephen Rappaport, PharmD, BCPS; Vidant Medical Center: Lauren Chambers, PharmD, BCCCP; Tyler Chanas, PharmD, BCCCP; Bethany Crouse, PharmD, BCCCP; Kaitlyn Robinson, PharmD. Publication fees will be provided by the place of employment for author JK: Loma Linda University. Non=nancial support was provided by the American College of Clinical Pharmacy Practice-Based Research Network as described in the manuscript.

Funders	Funder number
University of Rochester Medical Center
Loma Linda University
Nationwide Children's Hospital
Texas Tech University Health Sciences Center at Dallas
Texas Health Harris Methodist Hospital Fort Worth
University of North Texas System College of Pharmacy
Nova Southeastern University
American College of Clinical Pharmacy
Oklahoma State University Medical Center
BCPS
MacNeal Hospital

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1155/2024/6626899

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Groth, C. M., Droege, C. A., Sarangarm, P., Cucci, M. D., Gustafson, K. A., Connor, K. A., Kaukeinen, K., Acquisto, N. M., Chui, S. H. J., Dixit, D., Flannery, A. H., Glass, N. E., Horng, H., Heavner, M. S., Kinney, J., Peppard, W. J., Sikora, A., & Erstad, B. L. (2024). Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study). Critical Care Research and Practice, 2024, Article 6626899. https://doi.org/10.1155/2024/6626899

@article{ff00feaa96e346c29abe819daa1a2cd7,

title = "Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)",

abstract = "Objective. 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). Methods. 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. Results. Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54\% female (n = 13), 92\% intubated (n = 22), 25\% on CI vasopressors (n = 6), and 33\% on CI paralytics (n = 8). Ketamine indications were analgesia/sedation (n = 21, 87.5\%) and status epilepticus (n = 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\%; p=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 p=0.01), but this was not sustained (25-48H: 24 (2-246) mg and p=0.29). Common AEs were tachycardia (63\%), hypotension (54\%), secretions/suctioning (29\%), and emergence reactions (13\%). Conclusions. 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.",

author = "Groth, \{Christine M.\} and Droege, \{Christopher A.\} and Preeyaporn Sarangarm and Cucci, \{Michaelia D.\} and Gustafson, \{Kyle A.\} and Connor, \{Kathryn A.\} and Kimberly Kaukeinen and Acquisto, \{Nicole M.\} and Chui, \{Sai Ho J.\} and Deepali Dixit and Flannery, \{Alexander H.\} and Glass, \{Nina E.\} and Helen Horng and Heavner, \{Mojdeh S.\} and Justin Kinney and Peppard, \{William J.\} and Andrea Sikora and Erstad, \{Brian L.\}",

note = "Publisher Copyright: {\textcopyright} 2024 Christine M. Groth et al.",

year = "2024",

doi = "10.1155/2024/6626899",

language = "English",

volume = "2024",

journal = "Critical Care Research and Practice",

issn = "2090-1305",

publisher = "John Wiley and Sons Ltd",

}

Groth, CM, Droege, CA, Sarangarm, P, Cucci, MD, Gustafson, KA, Connor, KA, Kaukeinen, K, Acquisto, NM, Chui, SHJ, Dixit, D, Flannery, AH, Glass, NE, Horng, H, Heavner, MS, Kinney, J, Peppard, WJ, Sikora, A & Erstad, BL 2024, 'Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)', Critical Care Research and Practice, vol. 2024, 6626899. https://doi.org/10.1155/2024/6626899

TY - JOUR

T1 - Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)

AU - Groth, Christine M.

AU - Droege, Christopher A.

AU - Sarangarm, Preeyaporn

AU - Cucci, Michaelia D.

AU - Gustafson, Kyle A.

AU - Connor, Kathryn A.

AU - Kaukeinen, Kimberly

AU - Acquisto, Nicole M.

AU - Chui, Sai Ho J.

AU - Dixit, Deepali

AU - Flannery, Alexander H.

AU - Glass, Nina E.

AU - Horng, Helen

AU - Heavner, Mojdeh S.

AU - Kinney, Justin

AU - Peppard, William J.

AU - Sikora, Andrea

AU - Erstad, Brian L.

PY - 2024

Y1 - 2024

N2 - Objective. 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). Methods. 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. Results. Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (n = 13), 92% intubated (n = 22), 25% on CI vasopressors (n = 6), and 33% on CI paralytics (n = 8). Ketamine indications were analgesia/sedation (n = 21, 87.5%) and status epilepticus (n = 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%; p=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 p=0.01), but this was not sustained (25-48H: 24 (2-246) mg and p=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%). Conclusions. 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.

AB - Objective. 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). Methods. 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. Results. Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (n = 13), 92% intubated (n = 22), 25% on CI vasopressors (n = 6), and 33% on CI paralytics (n = 8). Ketamine indications were analgesia/sedation (n = 21, 87.5%) and status epilepticus (n = 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%; p=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 p=0.01), but this was not sustained (25-48H: 24 (2-246) mg and p=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%). Conclusions. 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.

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U2 - 10.1155/2024/6626899

DO - 10.1155/2024/6626899

M3 - Article

AN - SCOPUS:85201161035

SN - 2090-1305

VL - 2024

JO - Critical Care Research and Practice

JF - Critical Care Research and Practice

M1 - 6626899

ER -

Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study)

Abstract

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