Ketamine for Critically Ill Patients with Severe Acute Brain Injury: A Systematic Review with Meta-analysis and Trial Sequential Analysis of Randomized Clinical Trials.
Neurocritical care April 1, 2025 Trine Hjorslev Andreasen, Frederik Andreas Madsen, Marija Barbateskovic et al. 8 citations
Ketamine may be useful for patients with severe acute brain injury because it inhibits cortical spreading depolarization, a phenomenon linked to secondary brain injury. A systematic review of five randomized trials (total 149 participants) compared ketamine with sufentanil, fentanyl, other sedatives, or saline. The proportion of participants with one or more serious adverse events did not differ between ketamine and sufentanil or fentanyl (relative risk 1.45, 95% confidence interval 0.81-2.58; very low certainty). All outcomes had a high risk of bias. The evidence is very low certainty, and large, low-bias trials are needed to determine ketamine's effects on functional outcome and serious adverse events.