What question did this study set out to answer?

Evaluate the impact of ketamine sedation on clinical outcomes in critically ill patients with COPD or asthma.

May 20, 2026

A44-32 Hemodynamic Effects and Clinical Outcomes of Ketamine Sedation in Critically Ill Patients With COPD or Asthma: A Multicenter Retrospective Study

Key Points

Evaluate the impact of ketamine sedation on clinical outcomes in critically ill patients with COPD or asthma.
Retrospective study at three hospitals in South Korea
Involved 3,362 ICU patients with COPD or asthma; 169 received ketamine
Used propensity score matching to select 338 control subjects
No significant differences in 7-, 28-, or 90-day mortality (log-rank p = 0.502, 0.840, 0.618)
Ketamine associated with longer duration of mechanical ventilation (10.0 days vs. 7.5 days, p = 0.012)
Stable mean arterial pressure and vasopressor requirements in the ketamine group compared to significant declines in controls (p < 0.001)

Abstract

Abstract Rationale Because ketamine has bronchodilator properties, it is often recommended as a sedative for patients with chronic obstructive pulmonary disease (COPD) or asthma. However, its impact on clinical outcomes in these patients remains unclear. We aimed to evaluate the effects of ketamine in this population. Methods We conducted a retrospective study of adult intensive care unit patients with COPD or asthma who received sedatives at three hospitals in South Korea between 2016 and 2022. The study outcomes included mortality, duration of mechanical ventilation, blood pressure, and vasopressor use. Results Among 3,362 intensive care unit patients with COPD or asthma, 169 received ketamine, and 338 matched controls were selected using propensity score matching. Kaplan-Meier analysis showed no significant differences in 7-, 28-, or 90-day mortality between the two groups (log-rank p = 0.502, 0.840, and 0.618, respectively), and logistic regression confirmed that ketamine use was not associated with mortality (OR 1.11, 95% CI 0.77-1.63). However, ketamine use was associated with a longer duration of mechanical ventilation (10.0 6.0-20.5 days vs. 7.5 4.0-13.0 days, p = 0.012). Over the 24 hours before and after sedation, mean arterial pressure and vasopressor requirements remained stable in the ketamine group, whereas the matched control group exhibited a significant decline in mean arterial pressure (89.1 80.3-99.5 mmHg vs. 81.5 75.0-89.3 mmHg, p 0.001; Figure A) and an increase in vasopressor use (norepinephrine: 0.00 0.00-0.06 mcg/min/kg vs. 0.07 0.02-0.26 mcg/min/kg, p 0.001; vasopressin: 0.00 0.00-0.01 IU/min vs. 0.09 0.03-0.14 IU/min, p 0.001; Figure B and C, respectively). Conclusion Ketamine sedation in critically ill patients with COPD or asthma did not affect mortality but was associated with a longer duration of mechanical ventilation. However, the absence of significant hemodynamic deterioration suggests that ketamine may be a reasonable option for sedation in patients with hemodynamic instability. Further prospective studies are warranted to evaluate its safety and clinical benefits in this setting. This abstract is funded by: None

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