title: The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review.
abstract: OBJECTIVE
  We synthesize the available evidence on the effect of ketamine on intracranial and cerebral perfusion pressures, neurologic outcomes, ICU length of stay, and mortality.
  
  
  METHODS
  We developed a systematic search strategy and applied it to 6 electronic reference databases. We completed a gray literature search and searched medical journals as well as the bibliographies of relevant articles. We included randomized and nonrandomized prospective studies that compared the effect of ketamine with another intravenous sedative in intubated patients and reported at least 1 outcome of interest. Two authors independently performed title, abstract, and full-text reviews, and abstracted data from all studies, using standardized forms. Data from randomized controlled trials and prospective studies were synthesized in a qualitative manner because the study designs, patient populations, reported outcomes, and follow-up periods were heterogeneous. We used the Jadad score and Cochrane Risk of Bias tool to assess study quality.
  
  
  RESULTS
  We retrieved 4,896 titles, of which 10 studies met our inclusion criteria, reporting data on 953 patients. One study was deemed at low risk of bias in all quality assessment domains. All others were at high risk in at least 1 domain. Two of 8 studies reported small reductions in intracranial pressure within 10 minutes of ketamine administration, and 2 studies reported an increase. None of the studies reported significant differences in cerebral perfusion pressure, neurologic outcomes, ICU length of stay, or mortality.
  
  
  CONCLUSIONS
  According to the available literature, the use of ketamine in critically ill patients does not appear to adversely affect patient outcomes.
authors: Royal College Emergency Medicine Residency Training Program, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Lindsay
authors: L
authors: Cohen
authors: Royal College Emergency Medicine Residency Training Program, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Valerie
authors: V
authors: Athaide
authors: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Maeve E
authors: ME
authors: Wickham
authors: Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
authors: Mary M
authors: MM
authors: Doyle-Waters
authors: Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors: Nicholas G W
authors: NG
authors: Rose
authors: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada. Electronic address: chohl@mail.ubc.ca.
authors: Corinne M
authors: CM
authors: Hohl
mesh_terms: D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000494:pharmacology*; D000075202:Contraindications; D003422:Critical Care / Q000379:methods; D006801:Humans; D019586:Intracranial Hypertension / Q000139:chemically induced; D007427:Intracranial Pressure / Q000187:drug effects*; D007649:Ketamine / Q000009:adverse effects / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine