title: Ketamine for Analgosedation in the Intensive Care Unit: A Systematic Review.
abstract: OBJECTIVE
  To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit.
  
  
  METHODS
  MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients.
  
  
  RESULTS
  One trial evaluated opioid consumption as an outcome in postoperative critically ill patients who were randomized to ketamine or saline infusions. The mean cumulative morphine consumption at 48 hours was significantly lower in the ketamine group (58 ± 35 mg) compared to the morphine-only group (80 ± 37 mg; P < .05). Other trials showed the potential safety of ketamine in terms of cerebral hemodynamics in patients with traumatic brain injury, improved gastrointestinal motility, and decreased vasopressor requirements. The observational study and case reports suggest that ketamine is safe and effective and may have a role in patients who are refractory to other therapies.
  
  
  CONCLUSIONS
  Ketamine use may decrease analgesic consumption in the intensive care unit. Additional trials are needed to further delineate the role of ketamine for analgosedation.
authors.affiliation: 1 Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
authors.affiliation: 1 Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.|2 Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Martin
authors.affiliation: 1 Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Erstad
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007649:Ketamine / Q000627:therapeutic use*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: analgesia; critical care; hypnotics and sedatives; intensive care; ketamine; pain