Maghraby Nisreen, Almulihi Qasem Ahmed, Nemeth Joe, Alghanim Mohammed Hajay, Barbic David, Al Rajeh Ibrahim Khalil, M Haji Arwaa Khalid
KFHU Emergency Medicine Department, College of Medicine, Imam Abdulrahman bin Faisal University, Kingdom of Saudi Arabia.
Maastricht University, The Netherlands.
Arch Acad Emerg Med. 2025 May 29;13(1):e51. doi: 10.22037/aaemj.v13i1.2598. eCollection 2025.
Combining multiple drugs for intubation raises concerns such as increased side effects, medication errors, nursing workload, and costs. Ketamine, with its anesthetic and analgesic properties, shows promise as a sedative agent for post-intubation care. This study aimed to evaluate the efficacy and safety of ketamine infusion as the sole sedative for critically ill intubated patients.
Following PRISMA 2020 guidelines, we conducted a systematic review by searching Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Google Scholar up to May 10, 2024. We included studies assessing ketamine use for post-intubation sedation in critically ill adults or children. Study quality was assessed using the Newcastle-Ottawa scale, and meta-analysis was performed using a random-effects model.
The systematic review included 7 studies, with 4 studies included in the meta-analysis. There was no significant difference in mortality (OR = 1.52; 95% CI: 0.49-4.70, p = 0.46; I2 = 83%) or length of hospital stay (MD = 6.42; 95% CI: -1.42-14.26, p = 0.11; I2 = 84%) between the ketamine only and other groups. The most common adverse events in the ketamine infusion group were atrial fibrillation and agitation.
Single-agent ketamine infusion is effective and safe for critically ill intubated patients. No significant differences were found in mortality or hospital stay between ketamine only and other groups. Atrial fibrillation and agitation were the most common adverse effects.
联合使用多种药物进行插管会引发诸多问题，如副作用增加、用药错误、护理工作量加大以及成本上升。氯胺酮具有麻醉和镇痛特性，有望成为插管后护理的镇静剂。本研究旨在评估氯胺酮输注作为重症插管患者唯一镇静剂的疗效和安全性。
遵循PRISMA 2020指南，我们通过检索截至2024年5月10日的Ovid MEDLINE、Cochrane对照试验中央注册库和谷歌学术进行了系统评价。我们纳入了评估氯胺酮用于重症成人或儿童插管后镇静的研究。使用纽卡斯尔-渥太华量表评估研究质量，并采用随机效应模型进行荟萃分析。
系统评价纳入了7项研究，荟萃分析纳入了4项研究。仅使用氯胺酮组与其他组在死亡率（OR = 1.52；95% CI：0.49 - 4.70，p = 0.46；I² = 83%）或住院时间（MD = 6.42；95% CI： - 1.42 - 14.26，p = 0.11；I² = 84%）方面无显著差异。氯胺酮输注组最常见的不良事件是心房颤动和躁动。
单剂氯胺酮输注对重症插管患者有效且安全。仅使用氯胺酮组与其他组在死亡率或住院时间方面未发现显著差异。心房颤动和躁动是最常见的不良反应。
