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Does Ketamine Raise ICP in Children with TBI?

April 11, 2023

Written by Millie Cosse

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This retrospective study of thirty-three pediatric patients with severe traumatic brain injury (sTBI) demonstrated no increase in intracranial pressure (ICP) after administration of ketamine.

Why does this matter?
Prior studies have demonstrated increased ICP following administration of ketamine. However, these studies were limited by sample size and failed to control for important confounders including arterial CO2. This study joins a growing body of evidence that suggests ketamine might be safe to use in children with increased ICP after sTBI.

Is ketamine the key to low ICP?
This study retrospectively evaluated thirty-three pediatric patients with sTBI using invasive ICP monitoring data. Twenty-two patients were given ketamine for sedation or to treat ICP crises (ICP> 20 mmHg for ≥ 5 minutes), and eleven did not receive ketamine. ICP and cerebral perfusion pressure (CPP) measurements were obtained at 5 minutes before and 120 minutes after each dose of ketamine. To limit confounding, measurements obtained after additional ICP-lowering medications were omitted from analysis. Importantly, all patients in this study were sedated and mechanically ventilated with arterial CO2 maintained at 37 ± 2 mmHg. Investigators found no evidence that ketamine raises ICP and may be associated with a reduction in ICP when given during ICP crisis. There were no survival differences between ketamine and non-ketamine groups.

My takeaway: It’s difficult to describe the effect that one medication has on ICP when patients are receiving numerous other sedating and ICP-lowering medications (see table 2 in the article). That said, I think these authors did an excellent job attempting to eliminate confounding from their analysis, and they make a strong case for the need for larger prospective studies.

Acute Effects of Ketamine on Intracranial Pressure in Children with Severe Traumatic Brain Injury. Crit Care Med. 2023 Feb 24; e005806 DOI: 10.1097