The following is a summary of “Impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials,” published in the February 2024 issue of Critical Care by Abdildin, et al.

Researchers started a retrospective study to examine the outcomes of ketamine use in critically ill ICU patients.

They initially searched for RCTs in PubMed, Scopus, and the Cochrane Library in January but repeated it in December 2023. Included studies compared ketamine with other traditional agents used in the ICU. Synthesized evidence with RevMan v5.4, presenting results as forest plots, and utilizing trial sequential analysis (TSA) software v. 0.9.5.10 Beta, presenting results as TSA plots. Outcomes included mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.

The results showed that a meta-analysis included twelve RCTs with 805 ICU patients (398 in the ketamine group and 407 in the control group). Ketamine did not outperform the control group in mortality, pain, mean and cumulative opioid consumption, midazolam consumption, or ICU length of stay. However, the ketamine group showed a favorable delirium rate compared to the control group. The finding is statistically significant within conventional boundaries (alpha=5%) but lacks robustness in TSA. The limited number of patients pooled for each outcome constrains the applicability of these findings.

Investigators concluded that ketamine showed a potential benefit in reducing delirium compared to the control group, yet further studies are necessary due to limitations in the current data.

Source:accjournal.org/journal/view.php?number=1519