Ketamine for the Critically Ill: Case Series and Clinical Reflections

Background: Considering its unique pharmacology, ketamine has become a subject of interest for various therapeutic applications in intensive care as a dissociative anesthetic agent. The primary objective of this case series is to demonstrate the importance of using ketamine among patients who are critically ill. Various critical presentations have been explored by utilizing ketamine as one of the management strategies for these patients. Methods: We report six cases from our ICU where ketamine was used as either an adjunct or primary modality of treatment. These include refractory status asthmaticus, ARDS, acute pain management in an opioid-tolerant patient, refractory delirium, acute agitation and anxiety in an intubated patient, and neuropathic pain management. Results: In status asthmaticus, ketamine infusion improved bronchodilation and facilitated weaning from mechanical ventilation. In the course of ARDS, ketamine is allowed to reduce doses of sedatives and analgesics and to improve oxygenation. Ketamine provided effective analgesia in an opioid-tolerant patient and a patient with neuropathic pain. It also showed benefits in the management of refractory delirium, after which the level of consciousness and cooperation of the patient improved. Additionally, in a ventilated patient, intravenous ketamine lowered acute agitation and anxiety, followed by improved respiratory parameters. Conclusions: This case series illustrates the diverse utility of ketamine in critical care, ranging from managing asthma, ARDS, acute pain, delirium, and agitation to neuropathy management. The unique properties of ketamine, specifically its bronchodilatory effects, analgesic properties, and probably neuroprotective effects, make it a beneficial pharmacological adjunct or primary treatment in many clinical scenarios. However, proper dosing titrations and careful selection of the patient, with monitoring for possible adverse effects, are crucial when using ketamine in critically ill patients. Further studies are needed on evidence-based parameters for the appropriate application of ketamine in the different scenarios occurring in critical care.