Manasco AT, et al. - In view of the increasing use of ketamine as a sedative agent in mechanically ventilated patients, researchers analyzed existing literature as well as quantified the influence of ketamine in mechanically ventilated patients via a systematic review and meta-analysis. They identified 15 studies with 892 patients, by exploring EMBASE, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, conference proceedings, and reference lists. The included studies were randomized and nonrandomized. Ketamine use resulted in a decline in propofol infusion rate but did not influence fentanyl or midazolam, as shown in random effects meta-analytic models. Experts found no link of ketamine with mortality, on-target sedation, vasopressor dependence, or hospital length of stay. Most frequently experienced complications were cardiovascular (eg, tachycardia and hypertension). In terms of quantity and methodological quality, limited data exist concerning ketamine use in mechanically ventilated patients and the acquired data showed clinical benefit. A possible role of ketamine as a sedative-sparing agent was suggested, but ketamine may be related to harm. There is a necessity for high-quality investigations prior to the widespread adoption of ketamine earlier in the sedation pathway.