723: Valproic Acid Versus Quetiapine for Treatment of Delirium in Critically Ill Patients

Washburn, Natalie C.; Barron, C.N; Walroth, Todd

doi:10.1097/01.ccm.0000626632.87772.eb

Cited by 1 publication

(12 citation statements)

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“…Six had unmeasured delirium, 31 post ICU/non-ICU occurrence, 21 study subjects nonolanzapine, 10 abstracts only, 15 reviews only, nine case/case series, 16 secondary analyses, six editorials/reviews, one descriptive study, seven terminated/incomplete, and 21 unclassified studies were excluded. Finally, nine quantitative studies (four RCTs and five retrospective cohort studies) 15,[26][27][28][29][30][31][32][33] were included. The main characteristics of the included studies are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The diagnostic criteria of delirium were not all the same among the enrolled studies. Seven studies used CAM or CAM-ICU diagnostic criteria, 15,[28][29][30][31][32][33] and two studies used DSM-IV or DSM-5 diagnostic criteria. 26,27 All nine studies enrolled adult ICU patients.…”

Section: Resultsmentioning

confidence: 99%

“…26,27 All nine studies enrolled adult ICU patients. 15,[26][27][28][29][30][31][32][33] Three studies quantitatively analyzed the control of delirium severity. 26,27,29 Table 2 lists the bias risk assessment of RCTs, and Table 3 lists the bias risk assessment of retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…Data on the improvement of delirium symptoms were explored in seven studies (three RCTs and four retrospective cohort studies). 15,26,27,29,30,32,33 However, only three studies with data on delirium symptom relief could be combined for statistical analysis. 29,32,33 The effective rates of delirium symptom improvement in the olanzapine group and other intervention groups were 64.38% (103/160) and 57.70% (90/156), respectively.…”

Section: Olanzapine and Delirium Symptom Reliefmentioning

confidence: 99%

“…15,26,27,29,30,32,33 However, only three studies with data on delirium symptom relief could be combined for statistical analysis. 29,32,33 The effective rates of delirium symptom improvement in the olanzapine group and other intervention groups were 64.38% (103/160) and 57.70% (90/156), respectively. Heterogeneity was not statistically significant (I 2 = 0%, p = 0.68).…”

Section: Olanzapine and Delirium Symptom Reliefmentioning

confidence: 99%

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Olanzapine for the treatment of ICU delirium: a systematic review and meta-analysis

Liu

Gao

et al. 2023

Therapeutic Advances in Psychopharmacology

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Background: As an atypical antipsychotic drug, olanzapine is one of the most commonly used drugs for delirium control. There are no systematic evaluations or meta-analyses of the efficacy and safety of olanzapine for delirium control in critically ill adults. Objectives: In this meta-analysis, we evaluated the efficacy and safety of olanzapine for delirium control in critically ill adults in the intensive care unit (ICU). Data Sources and Methods: From inception to October 2022, 12 electronic databases were searched. We retrieved randomized controlled trials (RCTs) and retrospective cohort studies of critically ill adults with delirium that compared the effects of olanzapine and other interventions, including routine care (no intervention), nonpharmaceutical interventions and pharmaceutical interventions. The main outcome measures were the (a) relief of delirium symptoms and (b) a decrease in delirium duration. Secondary outcomes were ICU and in-hospital mortality, ICU and hospital length of stay, incidence of adverse events, cognitive function, sleep quality, quality of life, mechanical ventilation time, endotracheal intubation rate and delirium recurrence rate. We applied a random effects model. Results: Data from 10 studies (four RCTs and six retrospective cohort studies) involving 7076 patients (2459 in the olanzapine group and 4617 in the control group) were included. Olanzapine did not effectively relieve delirium symptoms (OR = 1.36, 95% CI [0.83, 2.28], p = 0.21), nor did it shorten the duration of delirium [standardized mean difference (SMD) = 0.02, 95% CI [−1.04, 1.09], p = 0.97] when compared with other interventions. Pooled data from three studies showed that the use of olanzapine reduced the incidence of hypotension (OR = 0.44, 95% CI [0.20, 0.95], p = 0.04) compared with other pharmaceuticals. There was no significant difference in other secondary outcomes, including ICU or hospital length of stay, in-hospital mortality, extrapyramidal reactions, QTc interval prolongation, or overall incidence of other adverse reactions. The number of included studies was not sufficient for performing a comparison between olanzapine and no intervention. Conclusion: Compared with other interventions, olanzapine has no advantage in alleviating delirium symptoms and shortening delirium duration in critically ill adults. However, there is some evidence that the rate of hypotension was lower in patients who received olanzapine than in those who received other pharmaceutical interventions. There was a nonsignificant difference in the length of ICU or hospital stay, in-hospital mortality, and other adverse reactions. This study provides reference data for delirium research and clinical drug intervention strategies in critically ill adults. Registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42021277232).

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