Approved Hospital Formulary
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Approved Hospital Formulary
1/25/21 cn ICU Ketamine for Sedation
January 26, 2021
From: "Chris Nixon" <chris.nixon@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, January 25, 2021 2:01:05 PM
Subject: ICU Ketamine for Sedation
Pharmacists,
A new powerplan, ICU Ketamine for Sedation, has been developed and approved for our critically ill adult patients. The powerplan contains several pieces that are important for pharmacists to be aware of. With the current propofol shortage use of this plan is expected to be higher than originally expected.
- Ketamine for continous sedation will be primarily used as ADJUNCT SEDATION in our ventilated and sedated patient population. The only indication where ketamine could potentially be first line is status asthmaticus and these patients will likely be in the process of getting intubated, if not already at the time of order.
- This infusion will function similarly to our other sedatives used in the ICU for continuous sedation. The initial rate of ketamine will be 5 mcg/kg/min with titrations every 15 minutes by 5 mcg/kg/min to obtain a RASS of -3 to 0. Note this RASS goal is different than our standard of -1 to 0. If the patient is also on a paralytic, the nurses have been intructed to follow our standard paralysis RASS goal of -4 to -5.
- The concerns with ketamine are the possibility of emergence reactions, increase in secretions, and its effect on hemodynamics. Ketamine can cause hallucinations, delirium, and agitation. Hemodynamically, ketamine can increase both HR and BP. Ketamine also increases respiratory secretion production.
- There is a warning box at the top of the powerplan explaining the risks of hypertension, respiratory secretions, and emergence reactions. Please use your clinical judgement when verifying this order set.
- On the powerplan you will find 2 medications that will be utilized to treat the above possible reactions. Ativan and Robinul will be available PRN to treat agitation and excess secretions respectively. Nursing staff will be required to notify the provider when these reactions are present and the medications are needed.
- If a provider chooses to order a bolus of ketamine (usually 0.5-1 mg/kg) prior to initiating the infusion it will be ordered outside of the powerplan. There is an order comment now on all ketamine IV push orders stating it is required to be administered by a provider only. If you notice a loading dose is ordered please call the RN for that patient and make sure they are aware of this.
- This powerplan is restricted to Critical Care/Pulmonology/Intensivists/Trauma (pending P&T approval tomorrow).
- This powerplan is not currently restricted by location. Use is expected primarily in MICU and STICU.
The education sheet for our nursing staff is also attached for your reference.
This plan is scheduled to go live this week.
Please reach out to me if you have any questions or concerns regarding this new powerplan.