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REVIEW

Antipsychotics for the Prevention and Treatment of Delirium in the Intensive Care Unit: What Is Their Role?

, PharmD, FCCM, FCCP & , MD, FRCP(C)
Pages 59-67 | Received 21 Jul 2010, Accepted 20 Dec 2010, Published online: 22 Mar 2011

REFERENCES

  • American Psychiatric Association: Task Force on DSM-IV. DSM-IV sourcebook. Washington, DC, American Psychiatric Press, 1994.
  • Skrobik Y. Delirium prevention and treatment. Crit Care Clin 2009;25:585–91.
  • Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 2005;9:R375–81.
  • Ely EW, Gautam S, Margolin R, The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001;27:1892–900.
  • Ely EW, Shintani A, Truman B, Speroff T, Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004;291:1753–62.
  • Milbrandt EB, Deppen S, Harrison PL, Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004;32:955–62.
  • Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001;27:1297–304.
  • Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007;33:66–73.
  • Jacobi J, Fraser GL, Coursin DB, Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119–41.
  • Ely EW, Margolin R, Francis J, May L, Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29:1370–9.
  • Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001;27:859–64.
  • Devlin JW, Fong JJ, Fraser GL, Riker RR. Delirium assessment in the critically ill. Intensive Care Med 2007;33:929–40.
  • Morandi A, Pandharipande P, Trabucchi M, Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med 2008;34:1907–15.
  • http://icudelirium.org
  • http://guidance.nice.org.uk/CG103
  • American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999;156(5 suppl):1–20.
  • Cheung CZ, Alibhai SM, Robinson M, Recognition and labeling of delirium symptoms by intensivists: does it matter? Intensive Care Med. 2008;34:437–46.
  • Seitz DP, Gill SS, van Zyl LT. Antipsychotics in the treatment of delirium: a systematic review. J Clin Psychiatry 2007;68:11–21.
  • Riker RR, Fraser GL, Cox PM. Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med 1994;22:433–40.
  • Breitbart W, Marotta R, Platt MM, A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996;153:231–7.
  • Schwartz TL, Masand PS. The role of atypical antipsychotics in the treatment of delirium. Psychosomatics 2002;43:171–4.
  • Anand HS. Olanzapine in an intensive care unit. Can J Psychiatry 1999;44:397.
  • Sipahimalani A, Sime RM, Massand PS. Treatment of delirium with risperidone. Int J Geriatr Psychopharmacol 1997;1: 24–6.
  • Breitbart W, Tremblay A, Gibson C. An open trial of olanzapine for the treatment of deliriumin hospitalized cancer patients. Psychosomatics 2002;43:175–82.
  • Torres R, Mittal D, Kennedy R. Use of quetiapine in delirium: case reports. Psychosomatics 2001;42:347–9.
  • Kim KY, Bader GM, Kotlyar V, Gropper D. Treatment of delirium in older adults with quetiapine. J Geriatr Psychiatry Neurol 2003;16:29–31.
  • Leso L, Schwartz TL. Ziprasidone treatment of delirium. Psychosomatics 2002;43:61–2.
  • Platt MM, Breitbart W, Smith M, Marotta R, Weisman H, Jacobsen PB. Efficacy of neuroleptics for hypoactive delirium. J Neuropsychiatry Clin Neurosci 1994;6:66–7.
  • Maneeton B, Maneeton N, Srisurapanont M. An open-label study of quetiapine for delirium. J Med Assoc Thai 2007;90:2158–63.
  • Takeuchi T, Furuta K, Hirasawa T, Perospirone in the treatment of patients with delirium. Psychiatry Clin Neurosci 2007;61:67–70.
  • Rea RS, Battistone S, Fong JJ, Devlin JW. Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy 2007;27:588–94.
  • Siddiqi N, Stockdale R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev 2007 Apr 18;(2):CD005563
  • Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database Syst Rev 2007 Apr 18;(2):CD005594.
  • Ely EW, Stephens RK, Jackson JC, Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004;32:106–12.
  • Patel RL, Gambrell MA, Speroff T, Delirium and sedation in the intensive care unit (ICU): survey of behaviors and attitudes of 1,384 healthcare professionals. Crit Care Med 2009;37:825–32.
  • Devlin JW, Bhat S, Burke C, Roberts R, Skrobik Y. Current critical care pharmacists’ perceptions and practices surrounding the treatment of delirium in the intensive care unit. Crit Care Med 2010;38:A1034.
  • Kalisvaart KJ, de Jonghe JFM, Bogaards MJ, Haloperidol prophylaxis for elderly hip surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 2005;53:1658–66.
  • Larsen KA, Kelly SE, Stern TA, Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 2010;51:409–18.
  • Fricchione GL, Nejad SH, Esses JA, Postoperative delirium. Am J Psychiatry 2008;165:803–12.
  • Ansaloni L, Catena F, Chattat R, Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg 2010;97:273–80.
  • Sharma ND, Rosman HS, Padhi ID, Tisdale JE. Torsades de Pointes associated with intravenous haloperidol in critically ill patients. Am J Cardiol 1998;81:238–40.
  • Hassaballa HA, Balk RA. Torsades de Pointes associated with the administration of intravenous haloperidol: a review of the literature and practical guidelines for use. Expert Opin Drug Saf 2003;2:543–7.
  • Kapur S, Remington G, Jones C, High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study. Am J Psychiatry 1996;153:948–50.
  • http://www.fda.gov/CDER/DRUG/InfoSheets/HCP/haloperidol.htm
  • Huyse F, van Schijndel RS. Haloperidol and cardiac arrest. Lancet 1988;2:568–9.
  • Menza MA, Murray GB, Holmes VF, Rafuls WA. Decreased extrapyramidal symptoms with intravenous haloperidol. J Clin Psychiatry 1987;48:278–80.
  • Jibson MD, Tandon R. New atypical antipsychotic medications. J Psychiatr Res 1998;32:215–28.
  • Seeman P. Atypical antipsychotics: mechanism of action. Can J Psychiatry 2002;47:27–38.
  • Ray WA, Chung CP, Murray KT, Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009;360:225–35.
  • Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ 2004;329:75.
  • Wang PS, Schneeweiss S, Avorn J, Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005;353:2335–41.
  • Girard TD, Pandharipande PP, Carson SS, Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med 2010;38:428–37.
  • Devlin JW, Roberts RJ, Fong JJ, 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;38:419–27.
  • Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 2004;30:444–9.
  • Sessler CN, Gosnell MS, Grap MJ, The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338–44.
  • Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999;27:1325–9.
  • Trzepacz PT, Bourne R, Zhang S. Designing clinical trials for the treatment of delirium. J Psychosom Res 2008;65:299–307.
  • Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009;180:1092–7.
  • Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW. Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care unit patients. Crit Care Med 2010;38:2311–8.
  • Skrobik Y. Protocols, practice, and patients—the case of alcohol withdrawal. Crit Care Med 2007;35:955.
  • Lat I, McMillan W, Taylor S, Janzen JM, The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med 2009;37:1898–905.
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–29.
  • Meltzer HY, Matsubara S, Lee JC. Classification of typical and atypical antipsychotic drugs on the basis of dopamine D-1, D-2 and serotonin-2 pKi values. J Pharmacol Exp Ther 1989;251:238–46.
  • Gareri P, De Fazio P, Stilo M, Ferreri G, De Sarro G. Conventional and atypical antipsychotics in the elderly: a review. Clin Drug Invest 2003;23:287–322.
  • Kahn RS, Fleischhacker WW, Boter H, Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371:1085–97.
  • Andreasen NC, Pressler M, Nopoulos P, Miller D, Ho BC. Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biol Psychiatry 2010;67:255–62.
  • Trzepacz PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsych 2000;5:132–48.
  • Morandi A, Jackson JC, Ely EW. Delirium in the intensive care unit. Int Review Psychiatry 2009;21:43–58.
  • Dantzer R, O'Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008;9:46–56.
  • Marquis F, Ouimet S, Riker R, Cossette M, Skrobik Y. Individual delirium symptoms: do they matter? Crit Care Med 2007;35:2533–7.
  • Wunsch H, Kahn JM, Kramer AA, Rubenfeld GD. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med 2009;37:3031–9.
  • Pandharipande P, Shintani A, Peterson J, Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 2006;104: 21–6.
  • Pandharipande PP, Pun BT, Herr DL, Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007;298:2644–53.
  • Riker RR, Shehabi Y, Bokesch PM, Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009;301:489–99.
  • Maldonado JR, Wysong A, Van Der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics 2009;50:206–17.
  • Schweickert WD, Pohlman MC, Pohlman AS, Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373:1874–82.
  • Needham DM, Korupolu R, Zanni JM, Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010;91:536–42.
  • Cole M, McCusker J, Dendukuri N, Han L. The prognostic significance of subsyndromal delirium in elderly medical inpatients. J Am Geriatr Soc 2003;51:754–60.
  • Meagher D, Trzepacz PT. Phenomenological distinctions needed in DSM-V: delirium, subsyndromal delirium, and dementias. J Neuropsychiatry Clin Neurosci 2007;19:468–70.
  • 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;33:1007–13.
  • Skrobik Y, Ahern S, Leblanc M, Marquis F, Awissi DK, Kavanagh BP. Protocolized ICU management of analgesia, sedation and delirium improves the analgesia and subsyndromal delirium rates. Anesth Analg 2010;111:451–63.
  • Skrobik Y. Haloperidol should be used sparingly. Crit Care Med 2002;30:2613–4.
  • Skrobik Y. Delirium treatment: an unmet challenge. Lancet 2010;27;376:1805–7.
  • Reade MC, O'Sullivan K, Bates S, Goldsmith D, Ainslie WR, Bellomo R. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care 2009;13:R75.

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