This publication is included in our collection because several Parkview pharmacists were involved in the data collection part and acknowledged for the assistance they provided to the overall article. See Comment.

The response of ICU patients to continuously infused ketamine when it is used for analgesia and/or sedation remains poorly established.

OBJECTIVES: To describe continuous infusion (CI) ketamine use in critically ill patients, including indications, dose and duration, adverse effects, patient outcomes, time in goal pain/sedation score range, exposure to analgesics/sedatives, and delirium.

DESIGN SETTING AND PARTICIPANTS: Multicenter, retrospective, observational study from twenty-five diverse institutions in the United States. Patients receiving CI ketamine between January 2014 and December 2017.

MAIN OUTCOMES AND MEASURES: Chart review evaluating institutional and patient demographics, ketamine indication, dose, administration, and adverse effects. Pain/sedation scores, cumulative doses of sedatives and analgesics, and delirium screenings in the 24 hours prior to ketamine were compared with those at 0-24 hours and 25-48 hours after.

RESULTS: A total of 390 patients were included (median age, 54.5 yr; interquartile range, 39-65 yr; 61% males). Primary ICU types were medical (35.3%), surgical (23.3%), and trauma (17.7%). Most common indications were analgesia/sedation (

CONCLUSIONS AND RELEVANCE: There is variability in the use of CI ketamine. Hemodynamic instability was the most common adverse effect. In the 48 hours after ketamine initiation compared with the 24 hours prior, proportion of time spent in goal pain/sedation score range increased and exposure to other analgesics/sedatives decreased.

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Crit Care Explor

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ACKNOWLEDGMENTS We thank the following individuals for their participation on the Ketamine-ICU Study Group:

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