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Sedation and analgesia management are essential for patients with sepsis or hemodynamic instability. Although considered safe concerning hemodynamic changes, ketamine use might cause a substantial rise in intracranial pressure (ICP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An interventional study was conducted at the intensive care unit of Zagazig University Hospitals from December 2021 to March 2023 and covered 100 adult patients with septic shock requiring mechanical ventilation, sedation, and vasopressors. Patients with acute brain injury were excluded. Noninvasive ICP including ICP derived from pulsatility index, ICP derived from diastolic flow velocity (ICP\n                      <jats:sub>FVd<\/jats:sub>\n                      ), and ICP derived from optic nerve sheath diameter, and hemodynamic monitoring were measured before adjunct low-dosage (0.3 mg\/kg\/hr) continuous ketamine infusion (T0), after 12 h (T1), and after 24 h of infusion (T2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline ICP derived from optic nerve sheath diameter, ICP derived from pulsatility index, and ICP\n                      <jats:sub>FVd<\/jats:sub>\n                      medians were 14.5 (interquartile range [IQR] 7), 16.8 (IQR 0.91), and 13.8 (IQR 9.38) mm Hg, respectively. Only ICP\n                      <jats:sub>FVd<\/jats:sub>\n                      showed a significant slight increase from 13.75 (IQR 8.5) at T1 to 13.90 (IQR 8.5) at T2 (\n                      <jats:italic>P<\/jats:italic>\n                      value\u2009=\u20090.042). The baseline median noninvasive cerebral perfusion pressure was 74.56 (IQR 12.39) mm Hg without significant change at T1 or T2 (\n                      <jats:italic>P<\/jats:italic>\n                      value\u2009=\u20090.09). The respiratory rate, heart rate, and mean arterial blood pressure showed no significant changes across timepoints (\n                      <jats:italic>P<\/jats:italic>\n                      values\u2009=\u20090.95, 0.86, and 0.14, respectively). The median doses of midazolam, fentanyl, and norepinephrine significantly decreased across the study timepoints, especially at the first 12 h (\n                      <jats:italic>P<\/jats:italic>\n                      value\u2009&lt;\u20090.001 for each).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The present pilot study showed promising results of low-dose continuous ketamine infusion adjunctly on ICP and hemodynamics with a substantial reduction of sedatives and vasopressor dose. Further studies with large sample sizes and longer duration of administration and follow-up are needed to expand the current findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-025-02302-4","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T13:27:28Z","timestamp":1750253248000},"page":"136-145","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients"],"prefix":"10.1007","volume":"44","author":[{"given":"Essamedin M.","family":"Negm","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8077-5911","authenticated-orcid":false,"given":"Hossam Tharwat","family":"Ali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanaa A.","family":"Nofal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Mosallem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashraf Elsayed","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Ali","family":"Morsy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamer S.","family":"Elserafy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwan","family":"Elgohary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled Mohamed","family":"Altaher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherif","family":"Sharaf EL Deen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hani A.","family":"Albialy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M.","family":"Gouda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Beniamen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"2302_CR1","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1056\/NEJMoa022139","volume":"348","author":"GS Martin","year":"2003","unstructured":"Martin GS, Mannino DM, Eaton S, Moss M. 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Gouda\u2019s affiliation and to update the ketamine infusion dosage from (0.3 \u03bcg\/kg\/hr) to (0.3 mg\/kg\/hr)..","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2025","order":8,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":9,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":10,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s12028-025-02373-3","URL":"https:\/\/doi.org\/10.1007\/s12028-025-02373-3","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}},{"value":"Our study was approved by the research ethical committee of the Faculty of Medicine, Zagazig University with the reference number ZU-IRB#:6928\u20136-9\u20132021, and it was registered at clinicaltrials.gov (NCT05149586) and conducted per the revised declaration of Helsinki. Before enrollment, as patients could not decide to participate in this study, written informed consent was obtained from first-degree relatives of all participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}},{"value":"ClinicalTrials.gov: NCT05149586.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical Trial Registration"}}]}}