Quetiapine for delirium prophylaxis in high-risk critically ill patients

Abraham, Matthew P.; Hinds, Melisande; Tayidi, Isson T.; Jeffcoach, David R.; Corder, James M.; Hamilton, Leslie A.; Lawson, Christie M.; Bollig, Reagan; Heidel, R. Eric; Daley, Brian; Taylor, J.; McMillen, J. Curtis

doi:10.1016/j.surge.2020.02.002

Cited by 18 publications

(18 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent study, quetiapine was used for delirium prophylaxis and the results revealed that the incidence of delirium was 45.5% and 77.6% in patients during the admission to ICU in the quetiapine group and the group that did not receive pharmacological prophylaxis, respectively. It is suggested that future studies investigate these results (27).…”

Section: Discussionmentioning

confidence: 96%

Comparison of the Effectiveness of Haloperidol Injection and Oral Quetiapine to Control Delirium in Patients in the Emergency Department and Intensive Care Unit – A Randomized Clinical Trial

Doluee

Shaye

Talebi

et al. 2021

ircmj

View full text Add to dashboard Cite

Background: Delirium is a psychiatric syndrome observed among patients with critical psychiatric disorders. Haloperidol is now one of the first-line drugs for the treatment of delirium. However, quetiapine can be considered as an appropriate substitute in patients with a high risk of extrapyramidal symptoms or long QT syndrome. Objectives: This study aimed to compare the effectiveness of intramuscular haloperidol and oral quetiapine to control delirium in patients in the emergency department and intensive care unit. Methods: This randomized clinical trial was performed during 2017-2018 on patients with delirium who were referred to the emergency department and intensive care unit of Imam Reza Hospital (referral center), Mashhad, Iran. Patients were divided into two groups of 100 patients per group through a random allocation technique . In this study, 5 mg of intramuscular haloperidol every 12 hours and 25 mg of oral quetiapine were prescribed daily for the patients in the control and intervention groups, respectively. The delirium severity score of each patient was evaluated before and three days after the intervention through Delirium Rating Scale-Revised-98. Results: In this study, the mean±SD age of participants was 60.2±14.1 years. The findings indicated that no significant difference was observed between haloperidol (22.7±1.9) and quetiapine (22.7±2.2) groups in terms of the baseline delirium severity score (P=0.95). The mean delirium severity scores of patients in haloperidol and quetiapine groups were 25.6±2.1 and 25.2±2.5, respectively. Based on the obtained results, the difference between the delirium severity scores of both groups was not statistically significant (P=0.24). Conclusion: Based on the results, oral quetiapine has a similar effect as intramuscular haloperidol and can be used as a substitute to this medicine for controlling the symptoms of patients with delirium.

show abstract

Section: Discussionmentioning

confidence: 96%

Comparison of the Effectiveness of Haloperidol Injection and Oral Quetiapine to Control Delirium in Patients in the Emergency Department and Intensive Care Unit – A Randomized Clinical Trial

Doluee

Shaye

Talebi

et al. 2021

ircmj

View full text Add to dashboard Cite

show abstract

“…Our case report focused on the pharmacologic management of an asymptomatic COVID-19-infected patient who later developed acute hyperactive delirium using an atypical antipsychotic, quetiapine. Quetiapine has been frequently used in intensive care units and inpatient medical units for the management of delirium in hospital settings [11]. It works by antagonizing serotonin 5hydroxy-tryptamine (5-HT2A), dopaminergic D1 and D2, histamine H1 and H2, and adrenergic α1 and α2 receptors, as well as acting as a partial agonist at the serotonin 5-HT1A receptors [1,12].…”

Section: Discussionmentioning

confidence: 99%

Delirium in COVID-19: An Atypical Case Managed With Quetiapine

Silva¹,

Gul²,

Aravally³

et al. 2022

Cureus

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) can present without the typical symptoms of respiratory tract infection. Delirium has been reported as a prominent feature leading to an atypical presentation in older adults infected with COVID-19. Here, we present the case of a 65-year-old female who came to our hospital with confusion and altered mental status. The patient maintained an asymptomatic course of illness after testing positive for COVID-19 two weeks prior to the hospital visit. An appropriate workup was done to rule out other causes of the patient's symptoms. During the next couple of days, the patient developed classic symptoms suggestive of delirium. The patient was eventually treated based on the general guidelines for delirium management due to the absence of adequate medical literature specifying the management of delirium in the population of interest. Thus, the patient was given a trial of an atypical antipsychotic, quetiapine, to which she responded well and was subsequently discharged one week later.

show abstract

“…Smaller prospective studies have demonstrated a reduction in the duration of sedatives and opioids in critically ill patients receiving quetiapine for delirium or delirium prophylaxis. 13,17 However, other larger, randomized, placebo-controlled trials demonstrated no change in concomitant sedative and opioid requirements in critically ill patients receiving antipsychotics for delirium. 18,19 Despite this equivocal evidence, quetiapine may be initiated by ICU clinicians as a sedative adjunct in mechanically ventilated adults.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Quetiapine as a Sedative Adjunct in Mechanically Ventilated Adults Without Delirium

et al. 2020

View full text Add to dashboard Cite

Background: Quetiapine is an atypical antipsychotic that is commonly used in the Intensive Care Unit (ICU). The utility of quetiapine as a sedative adjunct has not yet been evaluated, but has been described previously in studies evaluating quetiapine for delirium or delirium prophylaxis. Objective: To determine if adjunctive use of quetiapine reduces sedative dosage requirements among mechanically ventilated adults without delirium. Methods: This retrospective intrapatient comparator study included all mechanically ventilated adults admitted to a medical ICU who received quetiapine between July 1, 2013, and July 1, 2018. The primary outcome was the change in sedative dosage requirements over 24 hours following quetiapine initiation. Secondary outcomes included change in sedative dosage requirements 48 hours postquetiapine initiation, opioid dosage requirements 24 hours postquetiapine initiation, percent time at goal for both pain and sedation scores, depth of sedation, and QTc. Results: A total of 57 patients were included in the study cohort. There was no significant difference in 24-hour cumulative doses of propofol ( P = 0.10), dexmedetomidine ( P = 0.14), or benzodiazepines ( P = 0.14). During the 48-hour treatment period, there was a significant increase in dexmedetomidine requirements ( P = 0.03). There were no differences in 24-hour opioid dosage requirements, percent time at goal pain or sedation scores, depth of sedation, or QTc following quetiapine initiation. Conclusion and Relevance: Adjunctive use of quetiapine was not associated with a significant reduction in sedative dosage requirements 24 or 48 hours following initiation among mechanically ventilated adults without delirium.

show abstract

Quetiapine for delirium prophylaxis in high-risk critically ill patients

Cited by 18 publications

References 14 publications

Comparison of the Effectiveness of Haloperidol Injection and Oral Quetiapine to Control Delirium in Patients in the Emergency Department and Intensive Care Unit – A Randomized Clinical Trial

Comparison of the Effectiveness of Haloperidol Injection and Oral Quetiapine to Control Delirium in Patients in the Emergency Department and Intensive Care Unit – A Randomized Clinical Trial

Delirium in COVID-19: An Atypical Case Managed With Quetiapine

Effectiveness of Quetiapine as a Sedative Adjunct in Mechanically Ventilated Adults Without Delirium

Contact Info

Product

Resources

About