Pharmacologic prevention and treatment of delirium in intensive care patients: A systematic review

dc.contributor.authorSerafim, Rodrigo B.
dc.contributor.authorBozza, Fernando A.
dc.contributor.authorSoares, Marcio
dc.contributor.authorBrasil, Pedro Emanuel A.A. do
dc.contributor.authorTura, Bernardo Rangel
dc.contributor.authorEly, E. Wesley
dc.contributor.authorSalluh, Jorge I.F.
dc.description.abstractPurpose: The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. Materials and methods: We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. Results: From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001). Conclusion: The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
dc.identifier.citationSerafim RB, Bozza FA, Soares M, do Brasil PE, Tura BR, Ely EW, Salluh JI. Pharmacologic prevention and treatment of delirium in intensive care patients: A systematic review. J Crit Care. 2015 Aug;30(4):799-807. doi: 10.1016/j.jcrc.2015.04.005. Epub 2015 Apr 17. PMID: 25957498
dc.identifier.otherDOI: 10.1016/j.jcrc.2015.04.005
dc.publisherJournal of Critical Care
dc.subject.meshTreatment Outcomeen
dc.subject.meshRivastigmine / therapeutic useen
dc.subject.meshRisperidone / therapeutic useen
dc.subject.meshRespiration, Artificial / statistics & numerical dataen
dc.subject.meshQuetiapine Fumarate / therapeutic useen
dc.subject.meshPostoperative Complications / prevention & controlen
dc.subject.meshPostoperative Complications / drug therapyen
dc.subject.meshNeuroprotective Agents / therapeutic useen
dc.subject.meshLength of Stay / statistics & numerical dataen
dc.subject.meshIntensive Care Unitsen
dc.subject.meshHypnotics and Sedatives / therapeutic useen
dc.subject.meshHydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic useen
dc.subject.meshHaloperidol / therapeutic useen
dc.subject.meshDexmedetomidine / therapeutic useen
dc.subject.meshDelirium / prevention & controlen
dc.subject.meshDelirium / drug therapyen
dc.subject.meshCritical Illnessen
dc.subject.meshCritical Careen
dc.subject.meshAntipsychotic Agents / therapeutic useen
dc.titlePharmacologic prevention and treatment of delirium in intensive care patients: A systematic review
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