Effect of various antipsychotic regimens on incidence of delirium in critically ill adults

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Purpose:Delirium is common during critical illness but it is unknown whether the choice of antipsychotic or dosing strategy impacts delirium outcomes. We evaluated the incidence of delirium in critically ill adults receiving different antipsychotic regimens.Materials and methods:Single center retrospective cohort study of adult patients admitted to the intensive care unit (ICU). Patients who received haloperidol or quetiapine and scored negative on the Confusion Assessment Method for the ICU (CAM-ICU) prior to initiation were included. Patients were divided into four groups based on dosing schedule of the antipsychotic. The primary outcomes were the incidence and duration of delirium.Results:Eighty patients were included in the study. Patients received scheduled quetiapine (35%), PRN haloperidol (55%), and PRN quetiapine (10%). The overall incidence of delirium in patients receiving antipsychotics was 39%. The incidence of delirium was similar between the scheduled quetiapine group, PRN haloperidol and PRN quetiapine groups, at 39%, 50% and 36%, respectively (p = 0.79). The scheduled quetiapine group had a longer time to first episode of delirium, but this was not statistically significant (11 days vs 4.8 days vs 5.6 days; p = 0.20).Conclusions:There was no difference in incidence or duration of delirium between quetiapine and haloperidol regimens.HighlightsAntipsychotic use in the ICU is growing due to avoidance of benzodiazepinesCurrent guidelines suggest against pharmacologic prevention of deliriumStudies on use of antipsychotics for prevention of delirium show mixed results, but used various treatment regimensDelirium occurred in 36% to 50% of patients depending on the antipsychotic regimen receivedScheduled quetiapine was associated with a longer hospital length of stay

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