- In this meta-analysis, ketamine use resulted in invasive airway management in one-fifth of patients receiving it for excited delirium.
Why this matters
- Acutely agitated patients can make for a dangerous emergency department (ED) environment.
- Attempts to physically restrain such patients can harm them.
- Benzodiazepines and antipsychotics can cause important adverse effects.
- Overall, quality of the studies was fair.
- All studies reported on airway management.
- Proportion of patients requiring airway management: 20% (95% CI, 0.0489 -1.6505).
- 10 studies reported sedation (n=452):
- Proportion of patients experiencing successful sedation: 85% (95% CI, 0.71-0.93).
- Heterogeneity among studies was high in both groups of studies.
- Of 4 deaths, ketamine possibly contributed to 2.
- Systematic review and meta-analysis of 13 studies evaluating prehospital and ED use of ketamine for chemical restraint of agitated or delirious patients or those with behavioral disorders (n=674).
- Outcomes: rate of effective sedation; requirement for airway management (placement of supraglottic airway or endotracheal tube).
- Funding: None.
- Most studies retrospective; no randomized controlled trials.
- Most conducted in prehospital setting.
- Dosing, timing of ketamine varied, as did etiologies of agitation.
- Some less experienced providers may have mistakenly thought a dissociative state indicated a need for airway management.