Abstract | OBJECTIVE: To investigate the effect of early versus late versus no antipsychotic administration on intensive care unit (ICU) delirium. METHODS: This retrospective cohort study was conducted in 2 adult medical ICUs at a single tertiary care center in Boston, Massachusetts, from October 1, 2015, to May 31, 2016. The study included 322 patients stratified into those who first received antipsychotics < 48 hours after first positive or unscorable (due to sedation) modified Confusion Assessment Method (CAM-ICU-m) (early), > 48 hours after first positive or unscorable CAM-ICU-m (late), and never received antipsychotics. Primary outcomes were hours alive without delirium or coma and likelihood of delirium- coma resolution. Secondary outcomes included ventilator-free hours, likelihood of extubation, and 10-day mortality. In post hoc exploratory analyses, outcomes were reanalyzed excluding comatose patients. RESULTS: Mean ± SD delirium- coma-free hours were 63 ± 87 for patients who received antipsychotics early, 66 ± 92 for those who received antipsychotics late, and 89 ± 107 for those who never received antipsychotics (P = .71). Antipsychotic exposure did not impact delirium- coma resolution. Mean ventilator-free hours were 103 ± 87 for patients who received antipsychotics early, 90 ± 83 for those who received antipsychotics late, and 89 ± 101 for patients who never received antipsychotics ( P = .11). The hazard ratio (HR) for 10-day mortality among patients who received antipsychotics early was 0.68 (95% CI, 0.37-1.22) and 0.30 (95% CI, 0.10-0.88) for those who received antipsychotics late compared to those who never received antipsychotics (P = .03). After excluding comatose patients, the effect of antipsychotics on 10-day mortality was no longer observed (early HR = 0.57, 95% CI, 0.30-1.07; late HR = 0.57, 95% CI, 0.28-1.18; never HR = 1 [reference]; P = .14). CONCLUSION:
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Authors | Robyn P Thom, Melissa P Bui, Bernard Rosner, Polina Teslyar, Nomi C Levy-Carrick, Michael Klompas |
Journal | The primary care companion for CNS disorders
(Prim Care Companion CNS Disord)
Vol. 20
Issue 6
(Nov 15 2018)
ISSN: 2155-7780 [Electronic] United States |
PMID | 30476373
(Publication Type: Comparative Study, Journal Article)
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Copyright | © Copyright 2018 Physicians Postgraduate Press, Inc. |
Chemical References |
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Topics |
- Antipsychotic Agents
(administration & dosage, adverse effects)
- Coma
(mortality, therapy)
- Critical Illness
- Delirium
(mortality, therapy)
- Female
- Follow-Up Studies
- Humans
- Intensive Care Units
- Male
- Middle Aged
- Retrospective Studies
- Time Factors
- Treatment Outcome
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