Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Outcomes associated with ketamine administration following traumatic brain injury.
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Dallas Jonathan, Park Hyoungjin, Briggs Robert G, Cote David J, Attenello Frank J, Zada Gabriel
Аннотация
INTRODUCTION: Historical concern regarding Ketamine's potential to raise ICP has resulted in limited adoption in the setting of severe traumatic brain injury (TBI); however, recent studies have countered this notion. This study evaluates the association between early ketamine administration and acute clinical outcomes in severe TBI at the national level.
METHODS: The TriNetX database was used to identify TBI patients over a 10-year period who required ventriculostomy/ICP monitor placement and endotracheal intubation. Patients receiving ketamine within the first day (+Ketamine) were compared with those receiving no ketamine (-Ketamine). Cohorts were propensity score matched on demographics, other traumatic injuries, traumatic shock, and Glasgow Coma Scale (GCS). Eight outcomes were evaluated: mortality, brain death, persistent vegetative state, hydrocephalus, subsequent craniotomy/craniectomy, shunting, tracheostomy, and gastrostomy.
RESULTS: 7676 patients met inclusion criteria (1217 +Ketamine, 6459 -Ketamine). The +Ketamine group was younger (39.5 vs. 48.4 years, P < 0.001), had a higher proportion of male patients (79.3% vs. 71.1%, P < 0.001), and had higher rates of other traumatic injuries/traumatic shock (all P < 0.001). There were no differences in GCS distribution. After matching, 1181 patients remained in each cohort without significant differences in demographics, other traumatic injuries/shock, or GCS. Ketamine use was associated with lower rates of mortality (22.6% vs. 27.9%, P = 0.003) and brain death (4.1% vs. 7.6%, P < 0.001). Craniotomy/craniectomy rates were similar (36.4% vs. 37.2%, P = 0.701). Tracheostomy placement was more common in the +Ketamine group (45.0% vs. 38.1%, P = 0.001), while no differences were observed for persistent vegetative state, gastrostomy, hydrocephalus, or shunting.
CONCLUSION: In this cohort study of severe TBI patients, early ketamine administration was not associated with increased need for craniotomy/craniectomy and was associated with lower rates of mortality and brain death. These findings support the notion that early ketamine may be safe to use in the setting of TBI. Further validation with prospective studies is warranted.
METHODS: The TriNetX database was used to identify TBI patients over a 10-year period who required ventriculostomy/ICP monitor placement and endotracheal intubation. Patients receiving ketamine within the first day (+Ketamine) were compared with those receiving no ketamine (-Ketamine). Cohorts were propensity score matched on demographics, other traumatic injuries, traumatic shock, and Glasgow Coma Scale (GCS). Eight outcomes were evaluated: mortality, brain death, persistent vegetative state, hydrocephalus, subsequent craniotomy/craniectomy, shunting, tracheostomy, and gastrostomy.
RESULTS: 7676 patients met inclusion criteria (1217 +Ketamine, 6459 -Ketamine). The +Ketamine group was younger (39.5 vs. 48.4 years, P < 0.001), had a higher proportion of male patients (79.3% vs. 71.1%, P < 0.001), and had higher rates of other traumatic injuries/traumatic shock (all P < 0.001). There were no differences in GCS distribution. After matching, 1181 patients remained in each cohort without significant differences in demographics, other traumatic injuries/shock, or GCS. Ketamine use was associated with lower rates of mortality (22.6% vs. 27.9%, P = 0.003) and brain death (4.1% vs. 7.6%, P < 0.001). Craniotomy/craniectomy rates were similar (36.4% vs. 37.2%, P = 0.701). Tracheostomy placement was more common in the +Ketamine group (45.0% vs. 38.1%, P = 0.001), while no differences were observed for persistent vegetative state, gastrostomy, hydrocephalus, or shunting.
CONCLUSION: In this cohort study of severe TBI patients, early ketamine administration was not associated with increased need for craniotomy/craniectomy and was associated with lower rates of mortality and brain death. These findings support the notion that early ketamine may be safe to use in the setting of TBI. Further validation with prospective studies is warranted.