Purpose: To evaluate whether ketamine-based sedation is associated with a difference in duration of mechanical ventilation compared with standard sedation strategies in mechanically ventilated medical intensive care unit patients.
Methods: A single center retrospective study of patients admitted to the medical intensive care unit at a community teaching hospital between January 2023 and July 2025 was conducted. Patients administered continuous sedation with or without ketamine for at least 6 hours while mechanically ventilated for at least 24 hours were identified. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality, intensive care unit and hospital length of stay, CAM-ICU results, and fentanyl requirements. Patients on adjunctive ketamine were compared to those on standard sedation regimens. Baseline characteristics were collected and compared between groups. Continuous variables were analyzed using medians with interquartile ranges and compared using Mann-Whitney U. Categorical variables were compared using chi-square or Fisher’s exact tests. The study was IRB approved.
Results: Twenty-eight patients were included with 14 in each arm. Patients in the ketamine arm received adjunctive sedation with propofol, dexmedetomidine, or midazolam compared to patients sedated with at least two of the previously mentioned agents. Median duration of mechanical ventilation did not differ between the ketamine and standard sedation groups (10.6 days vs 8.4 days, p=0.603). Mortality was lower in the ketamine group (7.1% vs 50%, p=0.012). Hospital and intensive care unit length of stay were similar between groups. Patients receiving ketamine required higher median fentanyl doses (200 mcg/hr vs 100 mcg/hr, p=0.007).
Conclusion: Ketamine-based sedation was not associated with reduced duration of mechanical ventilation compared with standard sedation strategies. However, ketamine use was found to have a lower observed mortality. Larger prospective studies are needed to further evaluate the role of ketamine in intensive care unit sedation regimens.
