Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
2 papers in the library · 10 citations · publishing 2025
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.
Cortical spreading depolarisation (SD) is a pathological wave of brain cell activity that occurs frequently after severe acute brain injury and can worsen damage by reducing blood flow and increasing energy demand. Ketamine appears to inhibit SDs in laboratory and patient studies. The KETA-BID trial is a randomized, blinded feasibility and pilot study testing S-ketamine for SDs in adults undergoing surgery for traumatic brain injury, aneurysmal subarachnoid hemorrhage, or spontaneous intracerebral hemorrhage. Participants who develop SD clusters receive either continuous S-ketamine or placebo, with dosing adjusted based on SD occurrence. The primary outcome is SDs per hour after randomization. The trial will provide insight into SD and ketamine's clinical effects, potentially offering a new treatment.