John Marshall1, Shoshana J Herzig2, Michael D Howell3, Stephen H Le4, Chris Mathew5, Julia S Kats6, Jennifer P Stevens7. 1. Department of Pharmacy, Beth Israel Deaconess Medical Center. Electronic address: jmarshal@bidmc.harvard.edu. 2. Department of Medicine, Beth Israel Deaconess Medical Center. 3. Department of Medicine, Division of Pulmonary/Critical Care University of Chicago. 4. Department of Pharmacy Mount Auburn Hospital. 5. Department of Pharmacy Maimonides Medical Center. 6. Department of Pharmacy, Beth Israel Deaconess Medical Center. 7. Instructor of Medicine Harvard Medical School, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center.
Abstract
PURPOSE: The objective of this study was to quantify the rate at which newly initiated antipsychotic therapy is continued on discharge from the intensive care unit (ICU) and describe risk factors for continuation post-ICU discharge. MATERIALS AND METHODS: This is a retrospective cohort study of all patients receiving an antipsychotic in the ICUs of a large academic medical center from January 1, 2005, to October 31, 2011. Medical record review was conducted to ascertain whether a patient was newly started on antipsychotic therapy and whether therapy was continued post-ICU discharge. RESULTS: A total of 39,248 ICU admissions over the 7-year period were evaluated. Of these, 4468 (11%) were exposed to antipsychotic therapy, of which 3119 (8%) were newly initiated. In the newly initiated cohort, 642 (21%) were continued on therapy on discharge from the hospital. Type of drug (use of quetiapine vs no use of quetiapine: odds ratio, 3.2; 95% confidence interval, 2.5-4.0; P < .0001 and use of olanzapine: odds ratio, 2.4, 95% confidence interval, 2.0-3.1; P ≤ .0001) was a significant risk factor for continuing antipsychotics on discharge despite adjustment for clinical factors. CONCLUSIONS: Antipsychotic use is common in the ICU setting, and a significant number of newly initiated patients have therapy continued upon discharge from the hospital.
PURPOSE: The objective of this study was to quantify the rate at which newly initiated antipsychotic therapy is continued on discharge from the intensive care unit (ICU) and describe risk factors for continuation post-ICU discharge. MATERIALS AND METHODS: This is a retrospective cohort study of all patients receiving an antipsychotic in the ICUs of a large academic medical center from January 1, 2005, to October 31, 2011. Medical record review was conducted to ascertain whether a patient was newly started on antipsychotic therapy and whether therapy was continued post-ICU discharge. RESULTS: A total of 39,248 ICU admissions over the 7-year period were evaluated. Of these, 4468 (11%) were exposed to antipsychotic therapy, of which 3119 (8%) were newly initiated. In the newly initiated cohort, 642 (21%) were continued on therapy on discharge from the hospital. Type of drug (use of quetiapine vs no use of quetiapine: odds ratio, 3.2; 95% confidence interval, 2.5-4.0; P < .0001 and use of olanzapine: odds ratio, 2.4, 95% confidence interval, 2.0-3.1; P ≤ .0001) was a significant risk factor for continuing antipsychotics on discharge despite adjustment for clinical factors. CONCLUSIONS: Antipsychotic use is common in the ICU setting, and a significant number of newly initiated patients have therapy continued upon discharge from the hospital.
Authors: Philip S Wang; Sebastian Schneeweiss; Jerry Avorn; Michael A Fischer; Helen Mogun; Daniel H Solomon; M Alan Brookhart Journal: N Engl J Med Date: 2005-12-01 Impact factor: 91.245
Authors: P P Pandharipande; T D Girard; J C Jackson; A Morandi; J L Thompson; B T Pun; N E Brummel; C G Hughes; E E Vasilevskis; A K Shintani; K G Moons; S K Geevarghese; A Canonico; R O Hopkins; G R Bernard; R S Dittus; E W Ely Journal: N Engl J Med Date: 2013-10-03 Impact factor: 91.245
Authors: John W Devlin; Russel J Roberts; Jeffrey J Fong; Yoanna Skrobik; Richard R Riker; Nicholas S Hill; Tracey Robbins; Erik Garpestad Journal: Crit Care Med Date: 2010-02 Impact factor: 7.598
Authors: Peter Pronovost; Brad Weast; Mandalyn Schwarz; Rhonda M Wyskiel; Donna Prow; Shelley N Milanovich; Sean Berenholtz; Todd Dorman; Pamela Lipsett Journal: J Crit Care Date: 2003-12 Impact factor: 3.425
Authors: Karalea D Jasiak; Ellen A Middleton; James M Camamo; Brian L Erstad; Linda S Snyder; Yvonne C Huckleberry Journal: J Pharm Pract Date: 2012-11-26
Authors: Hannah Wunsch; Christian F Christiansen; Martin B Johansen; Morten Olsen; Naeem Ali; Derek C Angus; Henrik Toft Sørensen Journal: JAMA Date: 2014-03-19 Impact factor: 56.272
Authors: Lori A Herbst; Sanyukta Desai; Dan Benscoter; Karen Jerardi; Katie A Meier; Angela M Statile; Christine M White Journal: Transl Pediatr Date: 2018-10
Authors: Kendiss Olafson; Ruth Ann Marrie; James M Bolton; Charles N Bernstein; O Joseph Bienvenu; Maia S Kredentser; Sarvesh Logsetty; Dan Chateau; Yao Nie; Marcus Blouw; Tracie O Afifi; Murray B Stein; William D Leslie; Laurence Y Katz; Natalie Mota; Renée El-Gabalawy; Murray W Enns; Christine Leong; Sophia Sweatman; Jitender Sareen Journal: Intensive Care Med Date: 2021-09-08 Impact factor: 17.440
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: Melissa R Riester; Parag Goyal; Lan Jiang; Sebhat Erqou; James L Rudolph; John E McGeary; Nicole M Rogus-Pulia; Caroline Madrigal; Lien Quach; Wen-Chih Wu; Andrew R Zullo Journal: J Gen Intern Med Date: 2022-01-03 Impact factor: 6.473
Authors: Natalia Jaworska; Stephana J Moss; Karla D Krewulak; Zara Stelfox; Daniel J Niven; Zahinoor Ismail; Lisa D Burry; Kirsten M Fiest Journal: BMC Health Serv Res Date: 2022-10-21 Impact factor: 2.908
Authors: Antoinette B Coe; Rebecca E Bookstaver; Andrew C Fritschle; Michael T Kenes; Pamela MacTavish; Rima A Mohammad; Robert J Simonelli; Jessica A Whitten; Joanna L Stollings Journal: Hosp Pharm Date: 2019-01-28
Authors: Christina S Boncyk; Emily Farrin; Joanna L Stollings; Kelli Rumbaugh; Jo Ellen Wilson; Matt Marshall; Xiaoke Feng; Matthew S Shotwell; Pratik P Pandharipande; Christopher G Hughes Journal: Anesth Analg Date: 2021-09-01 Impact factor: 6.627