Ensayos clínicos

Inclusion Criteria:

• Age 18 years to 99 years.
• Male or female sex.
• Has been in the Mayo Clinic Florida ICU for the past 1 week.
• PHQ-9 score of 10 or higher.
• One of the following diagnoses:
  • acute myocardial infarction;
  • acute renal failure;
  • chronic obstructive pulmonary disease (COPD);
  • congestive heart failure;
  • end-stage liver disease;
  • patients requiring intra-aortic balloon pump (IABP) therapy or continuous renal replacement therapy (CRRT);
  • post-bone marrow transplant;
  • Acute Hypoxemic Respiratory Failure.
  • Acute on Chronic Hypoxemic Respiratory Failure;
  • Pre- or post- Lung, Liver or Heart Transplant or surgical overflows (such as abdominal aortic aneurysm, thoracotomy or tracheostomy).

Exclusion Criteria:

• Poor vital sign stability hypoxia: O2 < 95%, hypotension: SBP <  90 hypertension: SBP > 180.
• Heart rate: < 50 or > 120, or Respiratory Rate: < 10 or > 30.
• Altered mental status.
• Patient is unwilling to participate or provide informed consent.
• Any allergy to ketamine or diphenhydramine.
• Patient is female of child-bearing age and unwilling to provide urine or blood for HCG analysis.
• Pregnant or breastfeeding.
• Presence of intracranial mass or vascular lesion.
• Presence of a history of psychosis or hallucinations (as assessed by electronic chart review).
• Weight greater than 115 kg or less than 45kg.
• History of increased intracranial pressure/hypertensive hydrocephalus or increased intraocular pressure.
• Patient is acutely psychotic.
• Provider feels that patient currently or likely will require chemical and/or physical restraints.
• History of prolonged QT-interval.
• Current treatment includes any medication known to affect the N‐methyl‐D‐aspartate receptor system (e.g., lamotrigine, acamprosate, memantine, riluzole, or lithium).
• Patient in withdrawal from substance abuse or who have used hallucinogens (including cannabis) in the last month for any indication, as determined by the clinical interview and urine drug screening.