Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis

For decades, a single dogma has ruled neurotrauma resuscitation: Never use ketamine in TBI. The historical fear that ketamine spikes intracranial pressure (ICP) has kept one of the most versatile, hemodynamically friendly induction agents on the shelf—but is that fear based on fact or outdated physiology?   

 In this episode, we dissect a massive 2026 systematic review and meta-analysis from the Journal of Critical Care .  By analyzing over 6,000 patients across 15 studies—including four RCTs and strictly post-2015 data—this paper puts the "old myth" to the ultimate test .  We break down how the researchers compared ketamine against other agents like propofol and etomidate to evaluate hospital mortality, ICP crises, and adverse events in both adult and pediatric populations . 

The findings are practice-changing.  The data reveals zero association between ketamine use and ICP spikes or increased mortality, effectively debunking the classic contraindication .  However, the review uncovers a controversial "plot twist": a potential link to hypotension that challenges our assumptions about ketamine's stability in catecholamine-depleted trauma patients . 

 Tune in as we analyze the "study dominance bias" that complicates these hemodynamic results and discuss exactly how this evidence should reshape your airway strategy for the severe TBI patient .