{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:57:13Z","timestamp":1787169433133,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T00:00:00Z","timestamp":1672272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,7]]},"abstract":"Abstract<\/jats:title>\n \n Study Objective<\/jats:title>\n We aimed to evaluate the efficacy and safety of ketamine in ensuring comfort and sparing conventional drugs when used as an adjuvant for analgesia and sedation in the Pediatric Intensive Care Unit (PICU) as a continuous infusion (\u226512\u00a0h).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Observational prospective study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Tertiary\u2010care\u2010center PICU.<\/jats:p>\n <\/jats:sec>\n \n Patients<\/jats:title>\n All consecutive patients <18\u2009years who received ketamine for \u226512 h between January 2019 and July 2021.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n ketamine infusion for \u226512 h.<\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results<\/jats:title>\n \n Seventy\u2010seven patients (median age 16\u00a0months, Interquartile Range (IQR) 7\u201343) were enrolled. Twenty\u2010six percent of patients (\n n<\/jats:italic>\n \u00a0=\u00a020) were paralyzed, while 74% (\n n<\/jats:italic>\n \u00a0=\u00a057) were not. The median infusion duration was 90\u00a0h (IQR 39\u2013193), with doses between 15 (IQR 15\u201320) and 30\u2009\u03bcg\/kg\/min (IQR 20\u201350). At 24\u2009h of ketamine infusion, values of COMFORT\u2010B\u2010Scale (CBS) were significantly lower compared with values pre\u2010ketamine (\n p<\/jats:italic>\n \u2009<\u20090.001). Simultaneously, doses\/kg\/h of opioids and benzodiazepines significantly decreased at 24\u2009h (\n p<\/jats:italic>\n \u2009<\u20090.001 and\n p<\/jats:italic>\n \u00a0=\u00a00.002, respectively), while doses\/kg\/h of propofol (\n p<\/jats:italic>\n \u00a0=\u00a00.500) and dexmedetomidine (\n p<\/jats:italic>\n \u00a0=\u00a00.072) did not significantly change. Seventy\u2010four percent of non\u2010paralyzed patients (42\/57) had a decrease in CBS \u22652 points with no increase of concomitant analgosedation drugs. Among paralyzed patients (\n n<\/jats:italic>\n \u00a0=\u00a020), 13 (65%) had no increase of concomitant analgosedation within 24\u2009h after ketamine initiation. Overall, 55\/77 (71%) of patients responded to ketamine. The mean and maximum ketamine infusion dosages were significantly higher in the non\u2010responders (\n p<\/jats:italic>\n \u00a0=\u00a00.021 and 0.028, respectively). Eleven patients had adverse events potentially related to ketamine (hypersalivation, systemic hypertension, dystonia\/dyskinesia, tachycardia, and agitation) and six patients required intervention (dose reduction, suspension, or pharmacologic therapy). None of the patients developed delirium during ketamine infusion.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Ketamine used as a continuous infusion in the PICU might represent a valid strategy to ensure comfort and spare opioids and benzodiazepines in difficult\u2010to\u2010sedate PICU patients. Adverse events are minor and easily reversible. Future study will be needed to investigate long\u2010term outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/phar.2754","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:45:06Z","timestamp":1672015506000},"page":"622-631","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Is ketamine infusion effective and safe as an adjuvant of sedation in the\n PICU<\/scp>\n ? Results from the Ketamine Infusion Sedation Study (\n KISS<\/scp>\n )"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6036-1954","authenticated-orcid":false,"given":"Anna","family":"Tessari","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Department of Women and Children's Health University Hospital of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7109-0582","authenticated-orcid":false,"given":"Francesca","family":"Sperotto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pece","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit San Bortolo Hospital Vicenza 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