title: Discontinuance of life sustaining treatment utilizing ketamine for symptom management.
abstract: We present the case of an otherwise healthy 21-year-old female who developed severe respiratory failure following a minor procedure requiring ECMO and bi-level ventilation. During her protracted ICU course, she had significant difficulties with agitation and was titrated to the following regimen: hydromorphone 30 mg/hour, fentanyl 200 mcg/hour, dexmedetomidine 1.5 mcg/kg/hour, propofol at 70 mcg/kg/min, and midazolam at 20 mg/hour. We were consulted to assist in withdrawal of life prolonging measures at the family's request and given high doses of commonly used opioid and sedative medications successfully utilized methadone and ketamine for symptom control. This case study would indicate that in selected patients on high dose opioid and sedative medications prior to withdrawal of life prolonging measures ketamine may be considered for symptom management.
authors.affiliation: Danielle M. Noreika is with the Thomas Palliative Care Unit and is a Clinical Assistant Professor, Division of Hematology, Oncology, and Palliative Care, Medical College of Virginia.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Noreika
authors.forename: Patrick
authors.initials: P
authors.lastname: Coyne
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008020:Life Support Care; D010166:Palliative Care / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: Ketamine; agitation; high dose opioids; withdrawal of life prolonging measures