USO DA CETAMINA EM PACIENTES COM LESÃO CEREBRAL TRAUMÁTICA: EFEITOS SOBRE A PRESSÃO INTRACRANIANA E DESFECHOS NEUROLÓGICOS

ABSTRACT Introduction: Severe traumatic brain injury (TBI) is responsible for millions of cases and high mortality worldwide. Initial management and care in the intensive care unit, especially controlling hypotension and elevated intracranial pressure (ICP), are fundamental for prognosis. Guidelines recommend maintaining ICP below 22 mmHg and systolic blood pressure above 90 mmHg. Treatment includes sedation with short-acting medications, which can cause hypotension. Ketamine, an NMDA receptor antagonist, is widely used as a sedative in the ICU, especially in patients with hemodynamic instability, as it increases cardiac output and blood pressure. Despite this, its use in TBI cases has historically been limited due to the risk of increased ICP. However, smaller studies have not shown an increase in ICP with ketamine and have even suggested a reduction, in addition to indicating its neuroprotective potential. Objective: To analyze the effects of ketamine in patients with traumatic brain injury, focusing on its influence on ICP and associated neurological outcomes. Methodology: A narrative literature review conducted in June 2025, with searches in the PubMed and Virtual Health Library (BVS) databases. Standardized descriptors from Medical Subject Headings (MeSH) and Health Science Descriptors (DeCS) were used, including the English terms ketamine AND (brain injury OR traumatic brain injury) AND (intracranial pressure OR intracranial hypertension OR ICP), and the Portuguese terms Pressão Intracraniana AND Lesão Cerebral traumática AND Cetamina. Results and Discussion: Six studies were included in the review after applying eligibility criteria. The evidence indicated that ketamine did not increase ICP in most cases, being associated in some studies with its reduction, as well as improving cerebral perfusion pressure. Additionally, no significant neurological adverse effects related to ketamine use were observed, even in rapid intubation procedures and pediatric patients. Conclusion: It is concluded that ketamine is a safe and effective option for sedation in patients with TBI, even in emergencies, challenging previous concerns and expanding therapeutic possibilities in critical situations. Keywords: Intracranial pressure; Traumatic brain injury; Ketamine.