Department of Pharmacy, Moses H. Cone Memorial Hospital, Greensboro, NC.
Poison Control Center, Children's Hospital of Philadelphia, Philadelphia, PA.
Crit Care Med. 2020 Jun;48(6):899-911. doi: 10.1097/CCM.0000000000004335.
To assess the evidence and discuss the risks and clinical relevance of ketamine for the treatment of various disease states impacting the adult critically ill population.
A literature review was performed using PubMed evaluating primary literature published until August 2018.
Case reports, observational studies (cohort, case-control), and randomized controlled trials involving patients 18 years and older in a nonperioperative setting using either IV or intramuscular ketamine were included for analysis. Uses of ketamine discussed focused on critically ill patients in the ICU and emergency department settings.
Included studies were evaluated for dosing, outcomes, and adverse effects of ketamine. For each study, the design, population, intervention, investigated outcomes, and results were assessed.
The evidence was organized according to use of ketamine, which included pain, sedation, status asthmaticus, alcohol withdrawal syndrome, status epilepticus, and acute behavioral psychologic disturbances. Evaluation of the evidence was based on the included primary literature along with any related guideline recommendations.
Ketamine has suggested potential benefit in several disease states impacting critically ill patients including pain, alcohol withdrawal syndrome, status epilepticus, and acute agitation. Further supporting evidence is needed to validate its use in the setting of critical illness.
评估氯胺酮治疗各种影响成年危重病患者的疾病状态的证据，并讨论其风险和临床相关性。
使用 PubMed 进行文献回顾，评估截至 2018 年 8 月发表的原始文献。
纳入了在非手术环境中使用 IV 或肌内氯胺酮治疗的年龄在 18 岁及以上的患者的病例报告、观察性研究（队列、病例对照）和随机对照试验。讨论中氯胺酮的使用集中在 ICU 和急诊科的危重病患者。
对纳入的研究进行了剂量、结局和氯胺酮不良反应的评估。对每项研究，评估设计、人群、干预措施、调查结局和结果。
根据氯胺酮的用途，将证据进行了组织，包括疼痛、镇静、哮喘状态、酒精戒断综合征、癫痫持续状态和急性行为心理障碍。对证据的评估是基于纳入的原始文献以及任何相关的指南建议。
氯胺酮在包括疼痛、酒精戒断综合征、癫痫持续状态和急性激越在内的几种影响危重病患者的疾病状态中具有潜在益处。需要进一步的支持证据来验证其在危重病情况下的使用。
