{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:42:48Z","timestamp":1787013768632,"version":"build-2736575974"},"reference-count":76,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T00:00:00Z","timestamp":1724803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This Rapid Practice Guideline (RPG) aimed to provide evidence\u2010based recommendations for ketamine analgo\u2010sedation (monotherapy and adjunct) versus non\u2010ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up\u2010to\u2010date systematic review and meta\u2010analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence\u2010to\u2010decision framework were used to assess the certainty of evidence and to move from evidence to decision\/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients' values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data from 17 randomized clinical trials (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009898) and nine observational studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo\u2010sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28\u2009days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] \u22120.05\u2009days; 95% CI \u22120.07 to \u22120.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg\/kg\/h morphine equivalent) (MD \u221211.6; 95% CI \u221220.4 to \u22122.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient\u2010important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo\u2010sedation in critically ill adults on iMV when other analgo\u2010sedatives are available; and (2) using ketamine as an adjunct to non\u2010ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non\u2010ketamine usual care sedatives alone. Large\u2010scale trials should provide additional evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.14470","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T22:09:45Z","timestamp":1724882985000},"page":"1161-1178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Ketamine analgo\u2010sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9497-1451","authenticated-orcid":false,"given":"Marwa","family":"Amer","sequence":"first","affiliation":[{"name":"Medical\/Critical Pharmacy Division King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"},{"name":"College of Medicine and Pharmacy, Alfaisal University  Riyadh 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