791: IMPACT OF SEDATION WITH KETAMINE COMPARED TO BENZODIAZEPINES ON DELIRIUM IN THE INTENSIVE CARE UNIT

Introduction: The use of high-dose ketamine infusions for sedation has grown in popularity as an alternative to benzodiazepines in intensive care unit (ICU) patients. Currently, there is a paucity of literature describing the use of high-dose ketamine for sedation. The objectives of this study are to describe high-dose ketamine use in the ICU and its impacts on delirium compared to benzodiazepines. Methods: This is a single-center, retrospective cohort study of patients admitted to an ICU between 5/5/2018 and 12/1/2021. Neurocritical care and cardiovascular surgery patients were excluded. Patients included were mechanically ventilated for ≥ 48 hours and received either ketamine ≥ 1 mg/kg/hr or a benzodiazepine infusion (midazolam or lorazepam) for ≥ 24 hours during their index ICU stay. and baseline demographics, sedative drip information, CAM-ICU scores, hospital and ICU length of stay (LOS), duration of mechanical ventilation, and chloride disturbances were collected The primary outcome was the percentage of eligible ICU days CAM-ICU positive, and secondary outcomes included ICU LOS and duration of mechanical ventilation. Eligible ICU days were defined as days with a Richmond Agitation Sedation Scale score ≥ - 3, and a CAM-ICU positive day was defined as having one positive CAM-ICU score positive. Results: A total of 187 patients were included, with 70 and 117 patients in the ketamine and benzodiazepine groups, respectively. The mean age was 56.9 (14.7), and 64.2% were male. The percentage CAM-ICU positive days in the ICU was 68.1% for ketamine and 51.5% for benzodiazepines (p=0.15). The median ICU LOS in days was 20.1 (11.6, 38.9) for the ketamine arm compared to 15.9 (8.7, 26.0) for the benzodiazepine arm (p=0.069). The median duration of mechanical ventilation in days was 19.5 (7.4, 37.4) compared to 11 (6.1, 22.0) for ketamine and benzodiazepines respectively (p=0.053). Overall, 57.5% of ketamine arm patients and 44.1% of benzodiazepine arm patients died during hospitalization (p=0.17). Conclusions: Compared to benzodiazepine infusions, high-dose ketamine infusions did not result in a significantly different number of CAM-ICU positive ICU days, ICU LOS, or duration of mechanical ventilation.