Conflicting data exists on the pharmacologic management of intensive care unit (ICU) delirium. This review appraises the current evidence of pharmacologic management of ICU delirium.
Materials and Methods:
A systematic literature search of MEDLINE and Embase was conducted to answer the population, intervention, comparison, and outcome (PICO) question of: “Does the use of a pharmacologic agent compared to standard of care or placebo improve ICU delirium in a critically ill patient population?”
Results:
After application of the PICO question and the inclusion and exclusion criteria, 13 articles were included. Of these articles, 7 were prospective randomized controlled trials, 1 was a prospective nonrandomized controlled trial, and 5 were retrospective investigations. The included articles differed in the agents evaluated, primary outcome, and method of identifying delirium.
Conclusion:
The variability of outcomes illustrates the need for a large-scale investigation to further evaluate the role of pharmacologic management of ICU delirium.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: APA Press; 2013.
2.
BalasMCRiceMChaperonCSmithHDisbotMFuchsB. Management of delirium in critically ill older adults. Crit Care Nurse. 2012;32(4):15–26.
3.
OuimetSKavanaghBPGottfriedSBSkrobikY. Incidence, risk factors, and consequences of ICU delirium. Int Care Med. 2007;33:66–73.
4.
MehtaSCookDDevlinJW, et al.Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015:43(3):557–566.
5.
RompaeyBVElseviersMMSchuurmansMJShortridge-BaggettLMTruijenSBossaertL. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009;13(3):R77.
6.
ZaalIJDevlinJWPeelenLMSlooterAJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40–47.
7.
GirardTDJacksonJCPandharipandePP, et al.Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513–1520.
8.
PisaniMAKongSOJKaslSVMurphyTEAraujoKLVan NessPH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092–1097.
9.
LinSLiuCWangC, et al.The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med. 2004;32(11):2254–2259.
10.
ShehabiYRikerRRBokeschPM, et al.Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med. 2010;38(12):2311–2318.
11.
ElyEWShintaniATrumanB, et al.Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–1762.
12.
SalluhJIFSoaresMTelesJM, et al.Delirium epidemiology in critical care (DECCA): an international study. Crit Care. 2010;14(6):R210.
13.
PunBTElyEW. The importance of diagnosing and managing ICU delirium. Chest. 2007;132(2):624–636.
14.
MilbrandtEBDeppenSHarrisonPL, et al.Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004;32(4):955–962.
15.
McNicollLPisaniMAZhangYElyEWSiegalMDInouyeSK. Delirium in the intensive care unit: occurrence, and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591–598.
16.
JonesCGriffithsRDSlaterTBenjaminKSWilsonS. Significant cognitive dysfunction in non-delirious patients. Intensive Care Med. 2006;32(6):923–926.
17.
BarrJFraserGLPuntilloK, et al.American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.
18.
SkrobikYKBergeronNDumontMGottfriedSB. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30(3):444–449.
19.
GirardTDPandharipandePPCarsonSS, et al.Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38(2):428–437.
20.
DevlinJWRobertsRJFongJJ, et al.Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med. 2010;38(2):419–427.
21.
MichaudCJBullardHMHarrisSAThomasWL. Impact of quetiapine treatment on duration of hypoactive delirium in critically ill adults: a retrospective analysis. Pharmacotherapy. 2015;35(8):731–739.
22.
WeaverCBKane-GillSLGunnSRKirisciLSmithburgerPL. A retrospective analysis of the effectiveness of antipsychotics in the treatment of ICU delirium. J Crit Care. 2017;41:234–239.
23.
PageVJElyEWGatesS, et al.Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomized, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1(7):515–523.
24.
NeedhamDMColantuoniEDinglasVD, et al.Rosuvastatin versus placebo for delirium in the intensive care and subsequent cognitive impairment in patients with sepsis-associated acute respiratory distress syndrome: an ancillary study to a randomized controlled trial. Lancet Respir Med. 2016;4(3):203–212.
25.
CarrascoGBaezaNCabreL, et al.Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in nonintubated ICU patients: a nonrandomized controlled trial. Crit Care Med. 2016;44(7):1295–1306.
26.
van EijkMMRoesKCHoningML, et al.Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicenter, double-blind, placebo-controlled randomized trial. Lancet. 2010;376(9755):1829–1837.
27.
PageVJCasarinAElyEW, et al.Evaluation of early administration of simvastatin in the prevention and treatment of delirium in critically ill patients undergoing mechanical ventilation (MoDUS): a randomized, double-blind, placebo-controlled trial. Lancet Respir Med. 2017;5(9):727–737.
28.
KatoKYamadaYMaeharaM, et al.Blonanserin in the treatment of delirium. Psychiatry Clin Neurosci. 2011;65(4):389–391.
29.
MichaudCJThomasWLMcAllenKJ. Early pharmacological treatment of delirium may reduce physical restraint: a retrospective study. Ann Pharmacother. 2014;48(3):328–334.
30.
DevlinJWSkrobikYRikerRR, et al.Impact of quetiapine on resolution of individual delirium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study. Crit Care. 2011;15(5):R215.
31.
FoxMAElefritzJLHuangBMHunleyC. Comparison of lurasidone versus quetiapine for the treatment of delirium in critically ill patients [published online ahead of print]. J Intensive Care Med. 2018.
32.
LoebelACucchaaroJSarmaK, et al.Efficacy and safety of lurasidone 80 mg/day and 160 mg/day in the treatment of schizophrenia: a randomized double blind, placebo- and active-controlled trial. Schizohr Res. 2013;145(103):101–109.
33.
HaleGMKane-GillSLGroetzingerLSmithburgerPL. An evaluation of adverse drug reactions associated with antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. 2016;29(4):355–360.
34.
KusumiIBokuSTakahashiY. Pschopharmaoclogy of atypical antipsychoitcs drugs: from the receptor binding profile to neuroprotection and neurogenesis. Psychiatry Clin Neurosci. 2015;69(5):243–258.
35.
ElyEWMargolinRFrancisJJ, et al.Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–1379.
36.
BergeronNDuboisMJDumontMDialSSkrobikY. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859–864.
37.
ClinicalTrials.gov [Internet]. The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA (MIND-USA) Study (MIND-USA). Bethesda, MD: National Library of Medicine (US); 2000. https://clinicaltrials.gov/ct2/show/NCT01211522. Accessed March 30, 2018. Identifier NCT01211522.
38.
RivosecchiRMSmithburgerPLSvecSCampbellSKane-GillSL. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse. 2015;35(1):39–50.
