Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial

Eijk, MM Van; Kc, Roes; Honing, ML; Kuiper, Michael; Karakus, A; Jagt, Mathieu van der; Spronk, PE; Gool, Willem A. van; Mast, Roos van der; Kesecioğlu, Jozef; Slooter, AJ

doi:10.1186/cc9759

Cited by 36 publications

(50 citation statements)

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“…Most strikingly, a multicenter, randomized, double-blind, placebo-controlled trial of rivastigmine for the treatment of delirium in critically ill patients was prematurely terminated because rivastigmine was associated with a sharp trend toward increased mortality (22% vs 8%, P 5 0.07), longer duration of delirium (median days, 5 vs 3, P 5 0.06), and increased hospital length of stay (LOS) (median days, 29 vs 25, P 5 0.06) compared with placebo. 13 These studies suggest that the clinician should use ChEI therapy with caution in patients who have delirium, as these medications are unlikely to improve the delirium and may have unfavorable safety outcomes.…”

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confidence: 99%

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

Swan

Wagle

Thompson-Moore

et al. 2013

Journal of Hospital Medicine

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BACKGROUND Initiation of cholinesterase inhibitor (ChEI) therapy for delirium during hospitalization is ineffective and may be associated with increased morbidity and mortality. OBJECTIVE To describe the incidence of initiating ChEI therapy during hospitalization. DESIGN A retrospective cross‐sectional study. SETTING A tertiary‐care academic medical center. PATIENTS Inpatient admissions from September 2010 through March 2011 with ChEI administration. INTERVENTION None. MEASUREMENTS Incidence of ChEI exposure, initiation of ChEI therapy, initiation of antipsychotics and benzodiazepines, infection, in‐hospital mortality, and hospital length of stay. RESULTS The incidence of adult admissions with ChEI exposure and ChEI initiation was 23.2 (95% confidence interval: 21.2–25.4) and 2 (95% confidence interval 1.5‐2.8) per 1000 admissions, respectively. Of 476 admissions receiving ChEI, 9% (n = 42) initiated therapy during the hospital stay and 91% (n = 434) continued on previously started therapy. Patients initiated on ChEI therapy frequently had infection (20 of 42) and were commonly initiated on antipsychotics (14 of 42) and benzodiazepines (13 of 42). Patients were hospitalized for a median of 2 days (interquartile range, 1–4) before initiation of ChEI and were exposed to therapy for a median of 3 days (interquartile range, 2–6). Of the 41 patients discharged from the hospital, 90% (n = 37) had orders to continue the ChEI postdischarge. CONCLUSIONS Despite a lack of evidence to support the practice, 9% of patients who received ChEI therapy were initiated during the inpatient setting. These patients were not routinely screened for delirium and frequently received treatments associated with delirium. Journal of Hospital Medicine 2013;8:304–308. © 2013 Society of Hospital Medicine.

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confidence: 99%

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

Swan

Wagle

Thompson-Moore

et al. 2013

Journal of Hospital Medicine

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“…Early recognition and prevention of modifiable factors allow us to ameliorate their impact on patient outcomes. Moreover, the current approach to delirium in critically ill patients has been shifted from treatment to prevention 16,[20][21][22][23][24][25][26][27][28][29][30] and early mobilization 31,32 . The primary aim of this prospective, observational study was to evaluate the incidence of delirium among surgical, trauma and medical patients in one of the six-bed Intensive Care Units of the University Hospital Ostrava.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Káňová¹,

Sklienka²,

Kula³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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a Background and Aims. Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. Methods. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Results and Conclusions. Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

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“…В другом ис-следовании [79] была показана безопасность этого препарата, но его лечебный эффект был незначи-тельным. Два пилотных исследования были прекра-щены из-за смертельных случаев [80,81]. Для лечения делирия применялся также холин-ергический препарат цитиколин, но он оказался неэффективным [82].…”

Section: медикаментозные стратегии леченияunclassified

Post stroke delirium

Ma¹

2014

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial

Cited by 36 publications

References 0 publications

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Post stroke delirium

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