A retrospective analysis of the effectiveness of antipsychotics in the treatment of ICU delirium

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Purpose:Conflicting data exists on the efficacy of antipsychotics for treatment of intensive care unit (ICU) delirium. The purpose of this study was to compare time to delirium resolution for ICU patients who were managed with and without antipsychotics.Materials and methods:This retrospective cohort evaluation included patients admitted to 12 ICUs at 5 sites over 5 weeks diagnosed with delirium. The primary outcome was time to delirium resolution. Secondary outcomes included ICU length of stay (LOS), mortality, discharge disposition and delirium redevelopment. A Cox proportional hazards model explored the relationship between covariates including antipsychotics and time to delirium resolution.Results:A total of 255 patients met inclusion criteria; 69 (27%) received antipsychotics. In the antipsychotic group, time to resolution of delirium was longer (Median: 36 hours vs. 13 hours, p < 0.001) and ICU LOS was longer (Median: 5.9 days vs. 3.8 days, p = 0.005), but there were no differences in mortality or discharge disposition. Patients who used antipsychotics (HR = 0.512; 95% CI: 0.276–0.952) and received mechanical ventilation (HR = 0.381; 95% CI: 0.217–0.669) had slower rate for time to delirium resolution.Conclusions:While the treatment of delirium with antipsychotics remains common, antipsychotics were not associated with a shorter time to resolution of delirium.HIGHLIGHTSConflicting evidence exists for the efficacy of antipsychotics for the treatment of ICU deliriumTime to resolution of delirium was compared in delirious patients who were managed with and without antipsychoticsTime to resolution of delirium was significantly longer in patients that received antipsychoticsAntipsychotics and mechanical ventilation were associated with a slower rate of delirium resolution in a Cox modelICU delirium treatment should focus on non-pharmacological methods and reduction of delirium risk factors

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