Impact of Quetiapine Treatment on Duration of Hypoactive Delirium in Critically Ill Adults: A Retrospective Analysis

Michaud, Christopher J.; Bullard, Heather; Harris, Serena; Thomas, Wendy

doi:10.1002/phar.1619

Cited by 32 publications

(31 citation statements)

References 46 publications

(78 reference statements)

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“…Also, antipsychotics used to prevent and treat delirium were recognized as potential risk factors for ARDS . Thus the toolkit for managing ICU delirium in patients with ARDS should use a multimodal approach utilizing early nonpharmacologic and pharmacologic interventions to prevent ICU delirium and decrease the severity of delirium in patients who develop it during their hospital course . Patients should be carefully screened for ICU delirium because hyperactive and hypoactive delirium do not often occur in isolation, and hypoactive delirium is associated with more detrimental outcomes .…”

Section: Delirium In Ardsmentioning

confidence: 99%

“…Finally, in a retrospective analysis of medical and surgical ICU patients with hypoactive delirium who received either quetiapine or no intervention, quetiapine reduced the duration of delirium, and there was a trend toward decreased duration of mechanical ventilation. Interestingly, quetiapine was initiated earlier in the patients who had a shorter duration of delirium, and a shorter duration of delirium was associated with significantly shorter durations of mechanical ventilation and ICU and hospital lengths of stay .…”

Section: Antipsychotics For Delirium Treatmentmentioning

confidence: 99%

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Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Torbic

Duggal

2018

Pharmacotherapy

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Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, and they experience long-term cognitive impairment and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidity and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. However, antipsychotics are associated with many adverse effects including respiratory failure. Given the long-term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. This review investigates the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate the impact in special populations, particularly patients with ARDS.

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Section: Delirium In Ardsmentioning

confidence: 99%

Section: Antipsychotics For Delirium Treatmentmentioning

confidence: 99%

Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Torbic

Duggal

2018

Pharmacotherapy

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“…Quetiapine is an atypical antipsychotic drug, which has been shown to be effective in the treatment of mental health conditions. It is also widely used in ICUs because of its efficacy in treating ICU delirium [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Arrest Following a Single 25 mg Dose of Quetiapine: A Case Report

Chia

Poh

Ong

et al. 2020

The Journal of Critical Care Medicine

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IntroductionQuetiapine is commonly used in intensive care units (ICU) to treat delirium. Cardiopulmonary arrest caused by low dose quetiapine is unreported. Only two cases in the literature have reported acute respiratory failure after single doses of 50mg and 100mg respectively. We report a case of cardiopulmonary arrest in a patient after the administration of a single 25mg dose of quetiapine.Case presentationA 72-year-old Chinese female with multiple cardiovascular co-morbidities was admitted to the ICU intubated, following complications from an elective endovascular repair of an infrarenal abdominal aortic aneurysm. She was alert and extubated the following day. She subsequently showed signs of delirium and was administered a single 25mg dose of oral quetiapine. Seven hours after ingestion, she developed type 2 respiratory failure and eventually cardiopulmonary arrest. She was successfully resuscitated and other causes for cardiopulmonary arrest were excluded. Twenty-four hours following her cardiopulmonary arrest, her respiratory failure had completely reversed and she was extubated uneventfully.ConclusionThis case report demonstrates that a single dose of oral quetiapine 25mg is sufficient to cause respiratory failure and cardiopulmonary arrest. Caution is advised when prescribing quetiapine in the elderly, especially in those with impaired drug clearance.

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“…The evidence for utilizing antipsychotics to improve outcomes in patients with ICU delirium remains limited. 15,[17][18][19][20] Only one study has demonstrated a reduction in the duration of delirium in critically ill patients, although this was a small study of only 36 patients treated with quetiapine. 17 No study to date has found a significant reduction in mortality.…”

mentioning

confidence: 99%

Pharmacist‐driven discontinuation of antipsychotics for ICU delirium: A quasi‐experimental study

Stuart

Smith

Payter

et al. 2020

J Am Coll Clin Pharm

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Introduction The use of antipsychotics reduces the duration of intensive care unit (ICU) delirium. Continuation of antipsychotics prescribed for ICU delirium at hospital discharge has been an increasingly reported phenomenon with risk factors for continuation upon discharge identified. Objective To evaluate a pharmacist‐driven discontinuation protocol on the rate of patients with an antipsychotic continued at hospital discharge for ICU delirium. Methods This was a single‐center, retrospective quasi‐experimental study of patients admitted to the medical, surgical, or cardiac ICU started on antipsychotics for delirium. A protocol was developed for pharmacists to discontinue scheduled antipsychotics once delirium had resolved. The pre‐ and post‐protocol groups included patients between November 2015 to April 2016 and November 2017 to April 2018, respectively. The primary outcome was the rate of antipsychotic continuation at hospital discharge in the pre‐ and postprotocol groups. Secondary outcomes were related to antipsychotic use and adverse events. Chi‐square, Fisher's exact test, Mann‐Whitney U test, and t‐test were used as appropriate. Results A total of 158 patients were included. There were no differences in baseline demographics including age, gender, ICU type, baseline QTc, ICU length of stay (LOS) or hospital LOS (25 [13, 34] vs 19 [13, 30] days; P > .05). There was a significant reduction in the rate of antipsychotics continued at hospital discharge with 26 (32.9%) and 6 (7.6%) patients having therapy continued in the pre‐ and postprotocol groups, respectively (P < .001). No differences were noted in antipsychotic continuation upon transfer to floor, QTc prolongation, or recurrence of delirium within 7 days of antipsychotic discontinuation. Conclusions Implementation of a pharmacist‐driven antipsychotic discontinuation protocol for delirium was associated with a significant decrease in antipsychotic continuation at hospital discharge. The protocol did not result in a significantly higher incidence of QTc prolongation or recurrence of delirium. Future studies are needed to assess antipsychotic discontinuation in the ICU setting.

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Impact of Quetiapine Treatment on Duration of Hypoactive Delirium in Critically Ill Adults: A Retrospective Analysis

Abstract: In this mixed ICU population, treatment of hypoactive delirium with quetiapine was safe and reduced the duration of delirium compared with standard care alone. Prospective placebo-controlled studies are needed to further assess the role of antipsychotics in hypoactive delirium.

Cited by 32 publications

References 46 publications

Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Cardiopulmonary Arrest Following a Single 25 mg Dose of Quetiapine: A Case Report

Pharmacist‐driven discontinuation of antipsychotics for ICU delirium: A quasi‐experimental study

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