The application of a new regimen for short term sedation in the ICU (ketofol) – Case series

AbstractObjectiveSedation is an effective component of care in ICU patients. The aim of this study was to evaluate the safety and efficacy of ketamine/propofol combination in short term sedation for the critically ill patients in ICU.DesignProspective case series study.SettingIntensive care unit (ICU) in a tertiary hospital (Kasr Al Aini).MethodsFourteen critically ill patients who were mechanically ventilated and were in need for sedation were included in this case series. An initial bolus dose (500μg/kg) of ketamine/propofol 1:1 (ketamine 8mg/ml and propofol 8mg/ml) was given to all patients followed by a maintenance dose of 10μg/kg/min and the infusion dose adjusted (in 5μg/kg/min increments) to achieve Ramsay Sedation Scale of 4. Recorded parameters included heart rate, systolic blood pressure, Ramsay score, the need for use of noradrenalin and the recovery time from discontinuation of sedation.ResultsThe mean and standard deviation of the age of the patients was 60±14.5y and their APACHEII score ranged from 18 to 35. The median initial bolus dose of ketofol administered was 5ml of aliquot with median infusion rate 6ml/h (range: 4.8–7.5ml/h) only three patients (21.4%) needed the infusion rate to be increased to achieve Ramsay score 4. Only one patient experienced hypotension due to hypovolemia secondary to internal hemorrhage.ConclusionContinuous intravenous infusion of ketofol may provide adequate and safe short term sedation (less than 24h) for critically ill patients in the intensive care units, with rapid recovery and no clinically significant complications. Further studies with larger number of patients are required to evaluate and validate these findings

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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