Herrera PLJ, Etulaín GJE, Esquivel PA, Mazo MB, Aguirre SJS, Martínez DBA

Language: Spanish
References: 42
Page: 251-261
PDF size: 324.12 Kb.

ABSTRACT

Introduction: delirium is the most common manifestation of brain dysfunction in critically ill patients; this is a manifestation that is commonly under-identified and neglected in the ICU. Control of delirium is one of the therapeutic objectives within the ICU; however, establishing the onset time of a given drug is not yet known. Atypical antipsychotics are beginning to replace agents neuroleptics such as haloperidol for the treatment of psychiatric conditions as a result of its more favorable safety profile. Material and methods: the study included 80 patients under invasive mechanical ventilation for more than 24 hours and positive CAM-ICU. The main objective was to analyze the effectiveness of the use of quetiapine as a pharmacological adjuvant for the control of delirium, during weaning from sedation. Secondary objectives were the duration of delirium, use of sedoanalgesia, and time to wean from IMV. Results: 83.8% (n = 67) of patients had adequate control of delirium. It was observed that patients who received quetiapine had an odds ratio of 1.42 (95%CI 0.38-5.22) for delirium control. 75% (n = 60) of patients with invasive mechanical ventilation received adjuvant treatment with quetiapine during their stay in the ICU. There were no significant differences in the use of quetiapine in relation to sex, age, reason for admission, surgical history, PRE-DELIRIC, days of sedation, or days of IMV. Conclusion: the findings suggested that quetiapine is effective for the management of delirium in ICU patients under VMI, but not superior to other pharmacological and non-pharmacological measures used in our unit.

REFERENCES

1. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089-1103.

2. Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.

3. Wassenaar A, van den Boogaard M, van Achterberg T, Slooter AJ, Kuiper MA, Hoogendoorn ME, et al. Multinational development and validation of an early prediction model for delirium in ICU patients. Intensive Care Med. 2015;41(6):1048-1056.

4. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-e873.

5. Abraham MP, Hinds M, Tayidi I, Jeffcoach DR, Corder JM, Hamilton LA, et al. Quetiapine for delirium prophylaxis in high-risk critically ill patients. Surgeon. 2021;19(2):65-71.

6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association; 2013.

7. Slooter AJC, Otte WM, Devlin JW, Arora RC, Bleck TP, Claassen J, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020-1022.

8. Setters B, Solberg LM. Delirium. Prim Care. 2017;44(3):541-559.

9. Flaherty JH, Yue J, Rudolph JL. Dissecting delirium: phenotypes, consequences, screening, diagnosis, prevention, treatment, and program implementation. Clin Geriatr Med. 2017;33(3):393-413.

10. Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nat Rev Dis Primers. 2020;6(1):90.

11. Meagher D. Motor subtypes of delirium: past, present and future. Int Rev Psychiatry. 2009;21(1):59-73.

12. Hosker C, Ward D. Hypoactive delirium. BMJ. 2017;357:j2047.

13. Ouimet S, Riker R, Bergeron N, Cossette M, Kavanagh B, Skrobik Y. Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med. 2007;33(6):1007-1013.

14. Gibb K, Seeley A, Quinn T, Siddiqi N, Shenkin S, Rockwood K, et al. The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study. Age Ageing. 2020;49(3):352-360.

15. Smith TO, Cooper A, Peryer G, Griffiths R, Fox C, Cross J. Factors predicting incidence of post-operative delirium in older people following hip fracture surgery: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2017;32(4):386-396.

16. Abawi M, Pagnesi M, Agostoni P, Chiarito M, van Jaarsveld RC, van Dongen CS, et al. Postoperative delirium in individuals undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. J Am Geriatr Soc. 2018;66(12):2417-2424.

17. Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliat Med. 2013;27(6):486-498.

18. Krewulak KD, Stelfox HT, Leigh JP, Ely EW, Fiest KM. Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis. Crit Care Med. 2018;46(12):2029-2035.

19. Almeida IC, Soares M, Bozza FA, Shinotsuka CR, Bujokas R, Souza-Dantas VC, et al. The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients. PLoS One. 2014;9(1):e85332.

20. Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: an overview. Ann Intensive Care. 2012;2(1):49.

21. Davis DHJ, Skelly DT, Murray C, Hennessy E, Bowen J, Norton S, et al. Worsening cognitive impairment and neurodegenerative pathology progressively increase risk for delirium. Am J Geriatr Psychiatry. 2015;23(4):403-415.

22. Persico I, Cesari M, Morandi A, Haas J, Mazzola P, Zambon A, et al. Frailty and delirium in older adults: a systematic review and meta-analysis of the literature. J Am Geriatr Soc. 2018;66(10):2022-2030.

23. Nitchingham A, Kumar V, Shenkin S, Ferguson KJ, Caplan GA. A systematic review of neuroimaging in delirium: predictors, correlates and consequences. Int J Geriatr Psychiatry. 2018;33(11):1458-1478.

24. McCoy TH Jr, Hart K, Pellegrini A, Perlis RH. Genome-wide association identifies a novel locus for delirium risk. Neurobiol Aging. 2018;68:160.e9-160.e14.

25. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922.

26. Watt J, Tricco AC, Talbot-Hamon C, Pham B, Rios P, Grudniewicz A, et al. Identifying older adults at risk of delirium following elective surgery: a systematic review and meta-analysis. J Gen Intern Med. 2018;33(4):500-509.

27. Girard TD, Thompson JL, Pandharipande PP, Brummel NE, Jackson JC, Patel MB, et al. Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med. 2018;6(3):213-222.

28. Heymann A, Radtke F, Schiemann A, Lutz A, MacGuill M, Wernecke KD, et al. Delayed treatment of delirium increases mortality rate in intensive care unit patients. J Int Med Res. 2010;38(5):1584-1595.

29. De J, Wand AP. Delirium screening: a systematic review of delirium screening tools in hospitalized patients. Gerontologist. 2015;55(6):1079-1099.

30. van den Boogaard M, Schoonhoven L, Maseda E, Plowright C, Jones C, Luetz A, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40(3):361-369.

31. Hanison J, Umar S, Acharya K, Conway D. Evaluation of the PRE-DELIRIC delirium prediction tool on a general ICU. Crit Care. 2015;19(Suppl 1):P479.

32. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med. 1993;119(6):474-481.

33. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.

34. Tobar E, Romero C, Galleguillos T, Fuentes P, Cornejo R, Lira MT, et al. Método para la evaluación de la confusión en la unidad de cuidados intensivos para el diagnóstico de delírium: adaptación cultural y validación de la versión en idioma español. Med Intensiva. 2010;34(1):4-13.

35. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-1882.

36. Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin. 2017;33(2):225-243.

37. Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for critically ill patients with the ABCDEF bundle: results of the icu liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3-14.

38. Kotfis K, Marra A, Ely EW. ICU delirium - a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018;50(2):160-167.

39. Devlin JW, Roberts RJ, Fong JJ, Skrobik Y, Riker RR, Hill NS, 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.

40. Michaud CJ, Bullard HM, Harris SA, Thomas WL. Impact of quetiapine treatment on duration of hypoactive delirium in critically ill adults: a retrospective analysis. Pharmacotherapy. 2015;35(8):731-739.

41. Shi M, Miao S, Gu T, Wang D, Zhang H, Liu J. Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial. Drug Des Devel Ther. 2019;13:897-905.

42. Andersen-Ranberg NC, Poulsen LM, Perner A, Wetterslev J, Estrup S, Hastbacka J, et al. Haloperidol for the treatment of delirium in ICU patients. N Engl J Med. 2022;387(26):2425-2435.