The Association of Selective Serotonin Reuptake Inhibitors With Delirium in Critically Ill Adults: A Secondary Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychologic Dysfunction in ICU Survivors ICU Study

Austin, Charles; Yi, Joe; Lin, Feng‐Chang; Pandharipande, Pratik; Ely, E. Wesley; Busby‐Whitehead, Jan; Carson, Shannon S.

doi:10.1097/cce.0000000000000740

Cited by 8 publications

(8 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The percentage of patients in our sample receiving SSRIs (14.6%) is higher than the prevalence of antidepressant use prevalence in the general U.S. population (10%). 13,22 This echoes similar findings from prior work examining SSRIs in the critically ill. 16 This finding may reflect that patients requiring major surgery have a higher burden of mental health issues compared to the general population.…”

Section: Discussionmentioning

confidence: 99%

“…In a prior retrospective cohort study, we demonstrated that SSRI administration may be associated with decreased risk of delirium on the same day of administration and at 24 hours in critically ill adults. 16 However, this work was limited by the inability to adjust for daily severity of illness. To further elucidate the relationship between SSRIs and delirium, we sought to examine the association of SSRIs and delirium incidence in a cohort of postoperative adults that have daily severity of illness measures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Association of Selective Serotonin Reuptake Inhibitors with Delirium in Post-Operative Adults: A Secondary Analysis of a Post-Operative Dataset with Daily Severity of Illness Adjustment

Austin,

Bazemore,

et al. 2024

Delirium Communications

Self Cite

View full text Add to dashboard Cite

Background Postoperative delirium is a prevalent condition associated with increased mortality, difficulties with physical recovery from surgery and decreased long-term cognitive function, especially in older adults. Currently, there are no direct medical treatments for delirium. We recently found an association between SSRI administration and reduced delirium in a critically ill medical population. We sought to evaluate this association in a surgical population. SSRIs may provide a new treatment option for delirium; further exploration is warranted. We aimed to assess the association between selective serotonin reuptake inhibitors (SSRIs) and delirium in postoperative adults. Methods We undertook a secondary analysis of an existing cohort in a large Academic Medical Centre in the Southeast United States. Patients were adults (aged 18-99) requiring at least one night of hospital admission following a scheduled surgery, enrolled from July 2017 to September 2017. Our primary outcome was the incidence of delirium 24 hours after administration of an SSRI. Our exposure variable was any SSRI administration in the preceding 24 hours. We collected data on demographics, SSRI administration, overall severity of illness via the ASA grading system, and daily severity of illness via the Sequential Organ Failure Assessment (SOFA) score from the electronic medical record review. Results We collected data on 191 patients (mean age 56.8 years, SD +/- 16.7). One hundred ten (57.6%) were female, and 149 (78%) were White. Most patients, 183 (95.8%), were non-Hispanic. Twenty-eight (14.6%) were prescribed SSRIs at any point during the study period and 35 (18.3%) were delirious on day one. Unadjusted analysis demonstrated that patients receiving SSRIs had OR 1.60 for delirium the next day (p=0.41). After adjusting for age ASA, age, hospital LOS, and SOFA, patients receiving SSRIs had OR 1.44 for next-day delirium (p=0.48). Conclusions SSRIs administered in the postoperative period were not associated with delirium on the subsequent day. This finding conflicts with prior results from a critically ill population. The association of SSRIs with delirium requires further investigation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association of Selective Serotonin Reuptake Inhibitors with Delirium in Post-Operative Adults: A Secondary Analysis of a Post-Operative Dataset with Daily Severity of Illness Adjustment

Austin,

Bazemore,

et al. 2024

Delirium Communications

Self Cite

View full text Add to dashboard Cite

show abstract

“…Serotoninergic pathways from dorsal raphe nuclei play a central role in the maintenance of wakefulness and REM sleep suppression. Recent evidence points towards a protective role of selective serotonin reuptake inhibitors (SSRI) in ICU-related delirium [79]. Melatonin is the major regulator of circadian rhythm and, in the hospital setting, circadian misalignment is a recognized precipitating factor for delirium; moreover, the reduction of plasmatic levels of melatonin was associated with post-operative delirium [80].…”

Section: Discussionmentioning

confidence: 99%

Sleep and Stroke-Related Delirium: A Systematic Review

Brunetti

Rollo

Scala

et al. 2023

CTN

View full text Add to dashboard Cite

Study objectives: Sleep and circadian rhythms disorders are frequent in the acute stroke. Sleep modifications are likely to contribute to the development of stroke-related delirium, a common neuropsychiatric complication of acute stroke. This systematic review aimed to clarify the association between sleep modifications and the occurrence of delirium in patients with acute stroke. Methods: The current systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was performed on PubMed and Scopus databases. Only studies that provided data concerning sleep, or pre-existing sleep disorders, in acute stroke and performed a formal evaluation of delirium were included. Results: The literature search enabled the identification of 15 studies, which exhibited high heterogeneity in terms of study design, settings, sleep assessments, delirium measures, and types of sleep intervention. In the study quality assessment, the majority of the studies were rated as weak or moderate. In most of the cases, sleep was subjectively assessed by the patients or rated by clinicians. None of the studies performed polysomnography for the evaluation of sleep. Only four of the studies assessed the impact of a sleep intervention on delirium, suggesting the potentially protective role of sleep promotion in reducing the prevalence and severity of stroke-related delirium. Conclusions: The evidence arising from the present systematic review supports that sleep disruption is a potential promoting factor for stroke-related delirium. We suggest that a formal sleep assessment and sleep promotion should be included in routine stroke care.

show abstract

“…for the development of delirium, a secondary analysis of the BRAIN-ICU study recently demonstrated that the use of selective serotonin reuptake inhibitors (SSRIs) was associated with a decreased risk of delirium and coma. 36,37 These findings warrant further exploration to determine the association between baseline mental illness, effective chronic treatment (i.e., SSRI therapy) versus new initiation during critical illness, and subsequent impact on delirium.…”

Section: While Baseline Anxiety and Depression Are Known Strong Risk ...mentioning

confidence: 99%

“…Again, the relationship between the underlying disease state (i.e., hypertension, either controlled or uncontrolled), effective medication therapy, and delirium warrants further exploration. While baseline anxiety and depression are known strong risk factors for the development of delirium, a secondary analysis of the BRAIN‐ICU study recently demonstrated that the use of selective serotonin reuptake inhibitors (SSRIs) was associated with a decreased risk of delirium and coma 36,37 . These findings warrant further exploration to determine the association between baseline mental illness, effective chronic treatment (i.e., SSRI therapy) versus new initiation during critical illness, and subsequent impact on delirium.…”

Section: Select Medications That May Impact Icu Deliriummentioning

confidence: 99%

Precision‐based approaches to delirium in critical illness: A narrative review

2023

View full text Add to dashboard Cite

Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium in critical illness and its deleterious outcome has expanded since early reports. Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after “negative” trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha‐2 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long‐term outcomes including cognitive impairment.

show abstract

The Association of Selective Serotonin Reuptake Inhibitors With Delirium in Critically Ill Adults: A Secondary Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychologic Dysfunction in ICU Survivors ICU Study

Cited by 8 publications

References 23 publications

The Association of Selective Serotonin Reuptake Inhibitors with Delirium in Post-Operative Adults: A Secondary Analysis of a Post-Operative Dataset with Daily Severity of Illness Adjustment

The Association of Selective Serotonin Reuptake Inhibitors with Delirium in Post-Operative Adults: A Secondary Analysis of a Post-Operative Dataset with Daily Severity of Illness Adjustment

Sleep and Stroke-Related Delirium: A Systematic Review

Precision‐based approaches to delirium in critical illness: A narrative review

Contact Info

Product

Resources

About