The Reemergence of Ketamine for Treatment in Critically Ill Adults

Kimberly P. Hurth, PharmD, BCCCP; Anthony Jaworski, PharmD, BCCCP; Kristen B. Thomas, PharmD, BCPS; William B. Kirsch, PharmD, BCPS; Michael A. Rudoni, PharmD, BCPS, BCCCP; Kevin M. Wohlfarth, PharmD, BCPS, BCCCP, BCCP


Crit Care Med. 2020;48(6):899-911. 

In This Article


Ketamine is a well-known anesthetic with sedative and analgesic properties historically used during medical procedures and in the postoperative setting. Clinical experience in humans began in the 1960s when ketamine was used during surgical interventions at the University of Michigan. It attained U.S. Food and Drug Administration approval in 1970, gaining popularity for its profound analgesia and preservation of airway reflexes.[1] A short-acting derivative of phencyclidine, ketamine is one-tenth the potency of its parent compound and exhibits dissociative effects by perpetuating a dream-like detachment from the environment.[1,2] Despite potential for abuse and adverse neuropsychiatric reactions, recent literature has expanded our understanding of ketamine's unique pharmacology and explores utilizing its analgesic, sedative, anti-inflammatory, and antidepressant effects for many off-label indications.[3] This review aims to summarize several of the emerging off-label indications for ketamine in the critically ill. The more familiar uses of rapid sequence intubation and procedural sedation are beyond the scope of this review and will not be discussed. Utilization of the Strength of Recommendation Taxonomy criteria will be applied for ketamine use in each disease state discussed (Appendix, Supplemental Digital Content 1,[4]