Journal of Intensive Care Medicine
May 28, 2012
Patil Armenian, Tanya M. Mamantov, Ben Tsutaoka et al.
81 citations
Twelve people who took MDMA at a single rave were hospitalized in the San Francisco Bay area with life-threatening complications including seizures and hyperthermia. Eight needed emergency breathing tubes, and six had dangerously low blood pressure. Most had high potassium levels, acute kidney injury, and muscle breakdown. Two died, four survived with permanent neurological, muscle, or kidney damage, and six recovered without lasting harm. Ten had hyperthermia, with seven reaching extreme temperatures between 40.9°C and 43°C. Cooling took an average of 2.7 hours. Drug analysis of two confiscated capsules showed they contained 82% and 98% pure MDMA, with one capsule holding 270 mg—more than twice a typical dose. The MDMA-induced hyperthermia, worsened by large doses, a warm environment, and physical exertion, was a major cause of death and injury.
Journal of Intensive Care Medicine
December 1, 2024
Nicholas J Vollmer, Erin D Wieruszewski, Andrea M Nei et al.
3 citations
Among critically ill, mechanically ventilated patients, continuous infusion of sedative-dose ketamine did not improve delirium- or coma-free days compared with continuous infusion of benzodiazepines. The median number of delirium- or coma-free days within the first 28 days was 1.2 for ketamine and 1.8 for benzodiazepines, a difference that was not statistically significant. Patients receiving ketamine spent less time at a desired sedation level, received more propofol and fentanyl, and had a longer intensive care unit stay. The findings suggest that ketamine offers no advantage over benzodiazepines for reducing delirium or coma in this population.
Journal of Intensive Care Medicine
May 14, 2025
Nathan J Smischney, George Williams, Craig S Jabaley et al.
2 citations
Among critically ill adults undergoing endotracheal intubation, acute cardiovascular dysfunction (hemodynamic instability or cardiac arrest) occurred at similar rates with etomidate and ketamine but was more frequent with propofol than with non-propofol sedation. Exploratory meta-analysis showed no statistically significant difference between etomidate and ketamine (odds ratio 1.05) or between etomidate and propofol (odds ratio 0.91). However, etomidate was associated with lower survival to hospital discharge compared to ketamine (odds ratio 0.76). Limited data for other outcomes such as acute kidney injury, delirium, or length of stay revealed no clear differences among the sedative agents.
Journal of Intensive Care Medicine
January 7, 2026
Nestor Cordeiro Dos Santos Neto, R. Rolim Neto, Esther Frota Gomes et al.
1 citation
A systematic review and meta-analysis of eight randomized controlled trials with 1,645 patients found that ketamine or esketamine reduced the incidence of delirium by about half (odds ratio 0.50) compared to placebo. The benefit was significant in older adults (mean age over 60) but not in younger patients. However, neuropsychiatric adverse events such as hallucinations and nightmares were more common with ketamine (odds ratio 1.60). No consistent effects were seen on pain scores, opioid use, or length of hospital or ICU stay. The authors conclude that ketamine may help prevent delirium in older surgical patients, but the risk of neuropsychiatric side effects must be considered.
Journal of Intensive Care Medicine
April 16, 2026
Vrutti Patel, Saurabh Sujanyal, Lekhya Raavi et al.
Subanesthetic doses of ketamine improved specific depressive symptoms in critically ill intensive care unit patients without causing significant hemodynamic instability. In a retrospective study of 34 adults, including 18 solid organ transplant recipients, ketamine infusions (0.3-0.75 mg/kg over 40 minutes on three consecutive days) were associated with improvement in apparent sadness (90.0% vs 52.2%) and reported sadness (95.0% vs 59.1%). Among transplant recipients, improvement in apparent sadness remained significant (80.0% vs 41.7%). Heart rate increased transiently at 15-30 minutes post-infusion but returned to baseline by 60-90 minutes. Adverse effects included anxiety (12.5%), restlessness or agitation (10.4%), and dissociation (8.16%). These findings support ketamine's potential as a rapid-acting antidepressant in the ICU.