A meta-analysis of 12 randomized controlled trials involving 805 intensive care unit patients found that ketamine was not superior to other agents for mortality, pain, opioid or midazolam consumption, or length of stay. The analysis favored ketamine for reducing delirium rates, but this finding was not robust in sequential analysis, indicating that more trials are needed.
In mechanically ventilated patients after craniotomy, ketamine reduced depression and anxiety more than a combination of midazolam and morphine. Fifty patients were randomly assigned to receive either ketamine or midazolam plus morphine during mechanical ventilation in the ICU. Depression scores were significantly lower in the ketamine group at 2 months and 6 months after discharge. Anxiety scores were significantly lower in the ketamine group at 2 weeks and 6 months after discharge. Ketamine appears effective for long-term prevention and treatment of anxiety and depression in this population, though larger studies are needed to confirm these findings.