Evidence map›Paper›PMID 42042859›Full record

SynthesisCritical care explorations2026

Ketamine for Analgosedation in Critically Ill Mechanically Ventilated Children: A Systematic Review and Meta-Analysis.

David J Zorko, Domi Zou, Sameer Sharif, Karin Dearness, Bram Rochwerg, Melissa J Parker

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

David J ZorkoDivision of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Domi ZouHonours Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Sameer SharifDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Karin DearnessCampbell Information Consulting, Hamilton, ON, Canada.
Bram RochwergDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Melissa J ParkerDivision of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.

Funding

Department of Pediatrics, McMaster University n/aIncreasing capacity for Maternal and Paediatric Clinical Trials (IMPaCT) n/a
6 · The paper itself

Abstract

objectivesWe conducted a systematic review and meta-analysis to compare continuous ketamine infusion to other analgosedatives in critically ill children receiving invasive mechanical ventilation (IMV). DATA SOURCES: We searched four electronic databases and trial registries to September 1, 2025. We searched published conference abstracts from two major critical care conferences (2022 to 2025). STUDY SELECTION: We preregistered the protocol on PROSPERO (CRD42025631768). Reviewers screened abstracts and full texts independently and in duplicate. We included randomized controlled trials (RCTs) and nonrandomized studies comparing ketamine to other analgosedatives in critically ill children receiving IMV. DATA EXTRACTION: Independently and in duplicate, we conducted data extraction. We assessed risk of bias using the Risk Of Bias instrument for Use in SysTematic reviews for RCTs or Risk Of Bias In Nonrandomized Studies of Interventions tool, and certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation. We pooled data using random-effects models. DATA SYNTHESIS: We included three RCTs and five nonrandomized studies (n = 1436 participants). Pooled analysis demonstrated that ketamine may have no effect on IMV duration (mean difference, 0.00 d; 95% CI, 0.03 d fewer to 0.03 d more; low certainty) and may reduce opioid exposure (mean difference, -8.88 µg/kg cumulative fentanyl equivalents; 95% CI, -6.99 to -10.77; low certainty). We found an uncertain effect of ketamine on delirium, withdrawal, length of stay, clinically important hypotension, and mortality compared with other analgosedatives. Long-term outcomes were not measured in included studies.

conclusionsThere is a paucity of studies examining ketamine analgosedation in children receiving IMV, yielding mostly very low certainty evidence for patient-important outcomes due to imprecision and issues related to serious risk of bias of included studies. Methodologically rigorous RCTs are needed to better understand the potential role of ketamine analgosedation in the PICU.

Indexed as

AnalgesicsCritical IllnessKetamineRespiration, ArtificialChildHumansAnalgesicsKetaminecritical careintensive care unitsketaminepediatricssedation

Identifiers

PMID42042859
PMCPMC13120503

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.