Ketamine Use in Critically Ill Patients: Insights into Depressive Symptoms and Hemodynamic Changes.
Vrutti Patel, Saurabh Sujanyal, Lekhya Raavi, Sophia G Blumenfeld, Faiz Saleem, Said Bateh, Abby Hanson, Anek Jena, Shahin Isha, Katie L Kunze, Patrick W Johnson, Katheleen A Rottman Pietrzak, Michelle M Ojard, Ivan A Huespe, Sadia Z Shah, Pablo Moreno Franco, Michael A Edwards, Mohit Chauhan, Devang Sanghavi, Shapiro Anna
Journal of intensive care medicine April 16, 2026 DOI: 10.1177/08850666261438474 via PubMed
Summary
AI-generated from the abstractSubanesthetic doses of ketamine improved specific depressive symptoms in critically ill intensive care unit patients without causing significant hemodynamic instability. In a retrospective study of 34 adults, including 18 solid organ transplant recipients, ketamine infusions (0.3-0.75 mg/kg over 40 minutes on three consecutive days) were associated with improvement in apparent sadness (90.0% vs 52.2%) and reported sadness (95.0% vs 59.1%). Among transplant recipients, improvement in apparent sadness remained significant (80.0% vs 41.7%). Heart rate increased transiently at 15-30 minutes post-infusion but returned to baseline by 60-90 minutes. Adverse effects included anxiety (12.5%), restlessness or agitation (10.4%), and dissociation (8.16%). These findings support ketamine's potential as a rapid-acting antidepressant in the ICU.
Study at a glance
| Characteristics | Retrospective study Peer reviewed |
|---|---|
| Sample size | 34 |
| Population | Adults admitted to the intensive care unit who received intravenous ketamine for depressive symptoms |
| Intervention | Ketamine |
| Dose | 0.3-0.75 mg/kg over 40 min on three consecutive days |
| Duration | Up to 120 minutes after infusion for hemodynamic monitoring |
| Topics | Depression Ketamine |
| Keywords | Hemodynamic stability Intensive care unit |
| Key finding | Subanesthetic ketamine improved apparent sadness and reported sadness in ICU patients without significant hemodynamic instability. |
Abstract
BackgroundKetamine has demonstrated efficacy in treatment-resistant depression, primarily in psychiatric or outpatient populations. Its use in ICU patients remains underexplored, with limited data beyond case reports and small series. This study evaluated the association between subanesthetic ketamine infusions and improvement in depressive symptoms and hemodynamic changes in ICU patients.MethodsWe conducted a retrospective study of adults admitted to the ICU who received IV ketamine (0.3-0.75 mg/kg over 40 min on three consecutive days) for depressive symptoms. Changes in depressive symptoms were assessed using routine clinical documentation by physicians, nurses, and occupational and physical therapists. Hemodynamic parameters (blood pressure and heart rate) were recorded before and up to 120 min after infusion. The primary outcome was to evaluate depressive symptoms while the secondary outcome was to assess hemodynamic changes post transfusion.ResultsThirty-four patients met criteria, including 18 solid organ transplant recipients. Median age was 59 years; 61.8% were male. Ketamine was associated with improvement in apparent sadness (90.0% vs 52.2%, P < .05) and reported sadness (95.0% vs 59.1%, P < .05). In transplant recipients, improvement in apparent sadness remained significant (80.0% vs 41.7%, P < .05). Hemodynamic parameters remained stable; heart rate increased transiently at 15-30 min post-infusion, returning to baseline by 60-90 min. Adverse effects observed were anxiety (12.5%), restlessness and/or agitation (10.4%), and dissociation (8.16%).ConclusionSubanesthetic ketamine improved specific depressive symptoms in critically ill ICU patients without significant hemodynamic instability. These findings support its potential as a rapid-acting antidepressant in the ICU, warranting further prospective trials.