DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS A propensity-matched retrospective analysis (N=7,676; Journal of Clinical Neuroscience) found that ketamine administered within 24 hours of severe TBI was associated with 24% lower mortality risk and 49% lower brain death risk compared to no ketamine use. Findings challenge the longstanding practice of avoiding ketamine due to concerns about elevated intracranial pressure.
Clinical Considerations
- After propensity matching, mortality rates were 22.6% vs 27.9% favoring ketamine; brain death rates were 4.1% vs 7.6%
- Ketamine group showed higher tracheostomy rates after matching; associations with persistent vegetative state and gastrostomy did not survive matching
- Pre-matching reductions in hydrocephalus and shunting rates were not statistically significant after matching, limiting interpretation of those secondary outcomes
- Retrospective design, administrative coding reliance, and incomplete ICP data constrain causal inference
Practice Applications
- Review current sedation protocols for severe TBI patients in light of accumulating evidence challenging ICP concerns around ketamine
- Discuss these findings with neurocritical care and anesthesia colleagues when evaluating early sedation strategy
- Monitor prospective TBI sedation trials before formalizing ketamine as standard practice
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