Ketamine Applications in Critical Care Medicine

Ketamine has long been valued in critical care medicine for its unique combination of sedative, analgesic and dissociative anaesthetic properties. Unlike many other agents, it preserves respiratory drive and airway reflexes while maintaining cardiovascular stability, making it particularly useful in haemodynamically unstable patients. Its non-competitive antagonism of N-methyl-D-aspartate (NMDA) receptors contributes to potent analgesia and sedation at both anaesthetic and subanaesthetic doses. Beyond its primary roles in induction and maintenance of anaesthesia, ketamine is increasingly employed as an adjunct for analgosedation in mechanically ventilated patients, offering reductions in opioid and benzodiazepine requirements. In neurocritical care, evidence suggests that ketamine does not elevate intracranial pressure and may even confer neuroprotective effects through modulation of excitotoxic pathways. Emerging applications extend to the management of refractory bronchospasm, alcohol withdrawal resistant to benzodiazepines and as part of multimodal pain strategies. Ongoing research explores optimal dosing regimens, timing of initiation and its impact on patient-centred outcomes such as duration of mechanical ventilation, ICU length of stay and long-term neurological recovery. Globally, ketamine’s affordability and broad pharmacological profile underpin its practical significance, particularly in resource-limited settings where advanced airway management may be less accessible.

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Ketamine Applications in Critical Care Medicine publication trend

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Technical terms

Analgosedation: The combined use of analgesics and sedatives to achieve comfort and amnesia in critically ill patients, often during mechanical ventilation.

NMDA receptor antagonist: A compound that non-competitively inhibits N-methyl-D-aspartate receptors, reducing excitatory neurotransmission and producing analgesic and anaesthetic effects.

Intracranial pressure (ICP): The pressure within the skull, influenced by brain tissue, cerebrospinal fluid and cerebral blood volume, critical in neurocritical care management.

Cerebral perfusion pressure (CPP): The net pressure gradient driving cerebral blood flow, calculated as mean arterial pressure minus intracranial pressure, essential for maintaining adequate oxygen delivery to the brain.

References

1. Ketamine: 50 Years of Modulating the Mind. Frontiers in Human Neuroscience (2016).
2. Ketamine: Neuroprotective or Neurotoxic?. Frontiers in Neuroscience (2021).
3. Impact of Ketamine on Analgosedative Consumption in Critically Ill Patients: A Systematic Review and Meta-Analysis. Annals of Pharmacotherapy (2022).
4. Adjunctive ketamine for sedation in critically ill mechanically ventilated patients: an active-controlled, pilot, feasibility clinical trial. Journal of Intensive Care (2021).
5. Ketamine in acute phase of severe traumatic brain injury “an old drug for new uses?”. Critical Care (2021).
6. Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies. European Journal of Clinical Pharmacology (2022).
7. Adjunctive Use of Ketamine for Benzodiazepine-Resistant Severe Alcohol Withdrawal: a Retrospective Evaluation. Journal of Medical Toxicology (2018).