Ketamine-based ICU sedation and patient-centered outcomes: A systematic review and meta-analysis of mechanical ventilation duration, ICU length of stay, and delirium.

Ketamine has been shown to possess unique pharmacologic properties that make it an appealing adjunctive sedative for critically ill patients; however, its overall impact on key intensive care unit (ICU) outcomes remains uncertain. As such, this systematic review and meta-analysis was conducted to evaluate whether intravenous ketamine-based sedation improves mechanical ventilation duration (MVD), ICU length of stay (LOS), and delirium incidence in ICU patients compared with standard analgosedation. Following PRISMA guidelines, a comprehensive literature search was conducted across online databases through June 2025. Eligible studies included randomized or prospective controlled adult ICU trials comparing continuous intravenous ketamine or esketamine infusions with standard sedation regimens. Pooled mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Six studies comprising 903 ICU patients met inclusion criteria. MVD was reported in all six studies; ICU LOS was reported in five studies and delirium was reported in two studies. Ketamine-based sedation was associated with a significant reduction in ICU LOS and a significant decrease in delirium incidence (MD: -0.86; 95% CI: -1.51, -0.22 and OR: 0.55; 95% CI: 0.43-0.72, respectively). Although MVD trended shorter in the ketamine group, this difference did not reach statistical significance (MD: -0.30; 95% CI: -1.53, 0.92). These results support consideration of ketamine as an adjunct in multimodal ICU sedation strategies; however, the effect on ventilation duration remains uncertain. While this study's findings offer valuable comprehensive evaluations, further large-scale trials are needed to optimize dosing and confirm long-term benefits.