Zeiler Frederick A, Teitelbaum Jeanne, West Michael, Gillman Lawrence M
Section of Neurosurgery, Dept of Surgery, University of Manitoba, Winnipeg, Canada; Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada.
Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada.
J Crit Care. 2014 Dec;29(6):1096-106. doi: 10.1016/j.jcrc.2014.05.024. Epub 2014 Jun 4.
The purpose of the study was to perform a systematic review of the literature on the use of ketamine in nontraumatic neurological illness and its effects on intracranial pressure (ICP).
Articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to January 2014), and gray literature were searched. Two reviewers identified manuscripts on the administration of ketamine in nontraumatic neurological illness that recorded effects on ICP. The strength of evidence was adjudicated using the Oxford and Grading of Recommendation Assessment Development and Education (GRADE) methodology.
Our search produced a total of 179 citations. Sixteen articles, 15 manuscripts, and 1 meeting proceeding were included in the review. Across all studies, there were 127 adult and 87 pediatric patients described. Intracranial pressure did not increase in any of the adult studies reporting premedication during ketamine administration, with 2 studies reporting a decrease in ICP. No significant non-ICP-related adverse events from ketamine were recorded in any of the studies.
There exists Oxford level 2b, GRADE C evidence in adults and level 4, GRADE C in pediatrics to support that ketamine does not increase ICP in nontraumatic neurological illness when patients are sedated and ventilated, and in fact may lower it in selected cases.
本研究旨在对氯胺酮在非创伤性神经系统疾病中的应用及其对颅内压（ICP）影响的文献进行系统综述。
检索了MEDLINE、BIOSIS、EMBASE、Global Health、HealthStar、Scopus、Cochrane图书馆、国际临床试验注册平台（建库至2014年1月）以及灰色文献中的文章。两名评审员确定了关于氯胺酮在非创伤性神经系统疾病中应用且记录了对ICP影响的手稿。使用牛津和推荐分级评估、发展与教育（GRADE）方法判定证据强度。
我们的检索共得到179条引文。本综述纳入了16篇文章、15篇手稿和1篇会议论文集。在所有研究中，共描述了127例成年患者和87例儿科患者。在所有报告氯胺酮给药前用药的成年研究中，颅内压均未升高，有2项研究报告ICP降低。在任何研究中均未记录到氯胺酮引起的与ICP无关的显著不良事件。
有牛津2b级、GRADE C级证据支持，在成年患者中，当患者接受镇静和通气时，氯胺酮不会升高非创伤性神经系统疾病患者的ICP，事实上在某些情况下可能会降低ICP；在儿科患者中证据等级为4级、GRADE C级。
