Rodrigo B Serafim1, Fernando A Bozza2, Marcio Soares3, Pedro Emanuel A A do Brasil4, Bernardo R Tura5, E Wesley Ely6, Jorge I F Salluh7. 1. D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Hospital Copa D'Or, Rio de Janeiro, Brazil; Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: rodrigobserafim@gmail.com. 2. D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil. Electronic address: bozza.fernando@gmail.com. 3. D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: marciosoaresms@gmail.com. 4. D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: pedro.brasil@idor.org. 5. D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: tura@centroin.com.br. 6. Vanderbilt University School of Medicine, Nashville, TN, USA; Veteran Affairs Tennessee Valley Geriatric Research Education Clinical Center (VA-GRECC), Nashville, TN, USA. Electronic address: wes.ely@vanderbilt.edu. 7. D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: jorgesalluh@gmail.com.
Abstract
PURPOSE: The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. MATERIALS AND METHODS: We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. RESULTS: From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001). CONCLUSION: The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
PURPOSE: The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically illpatients. MATERIALS AND METHODS: We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. RESULTS: From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001). CONCLUSION: The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
Authors: Christina S Boncyk; Kimberly F Rengel; Pratik P Pandharipande; Christopher G Hughes Journal: Curr Opin Crit Care Date: 2019-06 Impact factor: 3.687
Authors: Samiha Mohsen; Stephana J Moss; Filipe Lucini; Karla D Krewulak; Henry T Stelfox; Daniel J Niven; Khara M Sauro; Kirsten M Fiest Journal: Crit Care Med Date: 2022-08-26 Impact factor: 9.296
Authors: Natalia Jaworska; Stephana Julia Moss; Karla D Krewulak; Zara Stelfox; Daniel Niven; Zahinoor Ismail; Lisa Burry; Kirsten Fiest Journal: BMJ Open Date: 2022-06-29 Impact factor: 3.006
Authors: Marija Barbateskovic; Laura Krone Larsen; Marie Oxenbøll-Collet; Janus Christian Jakobsen; Anders Perner; Jørn Wetterslev Journal: Syst Rev Date: 2016-12-07
Authors: Sébastien Dupuis; Dave Brindamour; Stephanie Karzon; Anne Julie Frenette; Emmanuel Charbonney; Marc M Perreault; Patrick Bellemare; Lisa Burry; David R Williamson Journal: Can J Anaesth Date: 2019-01-23 Impact factor: 5.063
Authors: Suzanne Forsyth Herling; Ingrid E Greve; Eduard E Vasilevskis; Ingrid Egerod; Camilla Bekker Mortensen; Ann Merete Møller; Helle Svenningsen; Thordis Thomsen Journal: Cochrane Database Syst Rev Date: 2018-11-23
Authors: Domingo Palacios-Ceña; José Miguel Cachón-Pérez; Rosa Martínez-Piedrola; Javier Gueita-Rodriguez; Marta Perez-de-Heredia; Cesar Fernández-de-las-Peñas Journal: BMJ Open Date: 2016-01-29 Impact factor: 2.692