Ketamine is increasingly recognized as a viable option for monotherapeutic sedation in mechanically ventilated patients, particularly due to its unique pharmacological properties. As an NMDA receptor antagonist, ketamine can provide effective sedation without the respiratory depression often associated with traditional sedatives such as benzodiazepines and propofol. This characteristic is especially beneficial in patients requiring prolonged mechanical ventilation, where maintaining respiratory function is crucial (Jung et al., 2022; Hui et al., 2022).
Recent studies underscore the safety and feasibility of continuous ketamine infusions for sedation in mechanically ventilated patients across diverse clinical populations, including adults and children in intensive care units (ICUs). A study demonstrated that continuous ketamine infusion provided adequate sedation and analgesia in mechanically ventilated patients, achieving desired sedation scores within acceptable ranges (Mishra et al., 2024; Heiberger et al., 2018). The approach has been particularly beneficial during the COVID-19 pandemic due to extended ventilation durations and shortages of alternative agents, prompting the exploration of ketamine as a primary sedative (Jung et al., 2022; Wyler et al., 2023).
Furthermore, ketamine's analgesic benefits can help reduce opioid requirements, thereby minimizing the risk of opioid-related side effects and tolerance in critically ill patients. In pediatric populations, introducing ketamine as part of a sedation rotation protocol significantly decreased fentanyl use, which highlights its potential in creating more balanced analgesic-sedation strategies for mechanically ventilated patients (Heiberger et al., 2018; Haliloğlu, 2022; Bradshaw et al., 2019). By effectively combining sedation with analgesia, ketamine is a favorable alternative for patients intolerant of standard sedation regimens, especially considering its minimal respiratory depressant effects (Hui et al., 2022; Treu et al., 2017).
However, the potential for emergence reactions—characterized by agitation upon awakening—remains a concern with ketamine. Despite this, studies indicate that the incidence of such reactions is manageable and rarely necessitates treatment interventions (Riccardi et al., 2023; Pruskowski et al., 2017). While there are discussions regarding long-term effects associated with ketamine use, particularly concerning cholestatic liver injuries reported in specific populations, these findings suggest the need for careful patient monitoring rather than outright contraindication (Wendel‐Garcia et al., 2022; Henrie et al., 2023).
In summary, ketamine is a promising monotherapeutic sedative for mechanically ventilated patients due to its analgesic properties, ability to preserve respiratory function, and reduced opioid requirements. Continued research and clinical application will likely further establish its role in sedation protocols, especially in response to evolving patient needs in critical care settings.
References:
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- Haliloğlu, M. (2022). Continuous infusion of ketamine for adjunctive analgosedation in mechanically ventilated patients with chronic obstructive pulmonary disease. Eurasian Journal of Pulmonology.
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