ArticleIntensive care medicine2025
Association of low-dose ketamine with hallucinations in critically ill patients: a target trial emulation.
Article in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pharmacological sedation strategies for therapeutic gastrointestinal endoscopy: a systematic review and network meta-analysis of randomised controlled trials.Frontiers in pharmacology · 2026Pooled it
- Ketamine, Etomidate, and Mortality in Emergency Department Intubations.JAMA network open · 2025Observational
- Opportunities, challenges and future perspectives for target trial emulation in critical care clinical research.Critical care (London, England) · 2025Review
- Beyond the dose: rethinking ketamine neurotoxicity in critical illness.Intensive care medicine · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeKetamine use is a potentially modifiable risk factor for hallucinations. We aimed to use target trial emulation to investigate the association between low-dose ketamine and development of hallucinations in critically ill patients in the intensive care unit (ICU).
methodsRetrospective study using data from a university affiliated ICU in Melbourne, Australia. Application of marginal structural models and parametric g-formulas to assess the impact of low-dose ketamine on the development of hallucinations.
resultsWe studied 7514 patients from June 2016 to April 2021. Of these, 625 patients (8%) received low-dose ketamine, beginning at a median of 0 (0-1) days from ICU admission and at a mean daily dose of 0.11 (0.08-0.15) mg/kg/h. Low-dose ketamine treated patients had a higher rate of hallucinations within 30 days of ICU admission (26% vs. 7%; p < 0.001) and the first episode of hallucination occurred earlier than in unexposed patient (2 [1-3] vs. 3 [1-7] days from ICU admission; p < 0.001). After adjustment for baseline and time-dependent confounders, low-dose ketamine was associated with a higher risk of hallucinations within 30 days (OR, 6.46 [95% CI 5.17-8.07]; p < 0.001). These findings were confirmed with parametric g-formulas.
conclusionsIn ICU patients, low-dose ketamine was strongly associated with an increased risk of hallucinations. However, these findings should be interpreted with caution due to the observational nature of the study and the risk of residual confounding.
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