.jpg "Souheila Hammoud, PharmD photo")
Souheila Hammoud, PharmD
Clinical Pharmacist
Saint Joseph Mercy Oakland
Pontiac, MI
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Dustin Gladden, PharmD, BCCCP
Clinical Pharmacy Specialist - Medical Critical Care
St. Joseph Mercy Oakland, United States
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Kaitlyn DeHoff, PharmD, BCCCP
Clinical Pharmacy Specialist - Medical/Surgical Services
Saint Joseph Mercy Oakland, United States
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Title: Safety and efficacy of quetiapine use for delirium in the intensive care unit
Introduction: The 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU" recommend against the use of antipsychotics for prevention and treatment of delirium based on no evidence of benefit, unless non-pharmacologic therapies fail. The purpose of the study is to assess the efficacy and safety of quetiapine use for intensive care unit (ICU) delirium and to evaluate its continuation upon ICU and hospital discharge.
Methods: This retrospective cohort study evaluated critically ill adults with delirium, defined as positive CAM-ICU for >24 hours, admitted to the medical, surgical, or cardiovascular ICU at a community teaching hospital between January 2017 and January 2020. Excluded patients had active alcohol withdrawal, history of neurocognitive disorder, antipsychotic use prior to admission, or received continuous infusion of a paralytic agent. Patients were divided into two groups: those managed with quetiapine and those managed without quetiapine. The primary outcome was quetiapine efficacy based on time to delirium resolution and percent of time spent without ICU delirium. Secondary safety outcomes included mortality, change in QTc interval, and quetiapine duration of therapy upon discharge.
Results: During the study period, 150 patients were identified (quetiapine=90, no quetiapine=60). Patients who received quetiapine had a longer time to delirium resolution (quetiapine 96 hours [IQR 48-142.5] vs. no quetiapine 44.2 hours [IQR 21.7-93.8]; p< 0.001). The percent of time spent without ICU delirium was similar between groups (quetiapine 27.2% [IQR 7.8-47] vs. no quetiapine 24.7% [IQR 9-37.6]; p=0.869). ICU mortality was similar between groups (p=0.054). The mean change in QTc when CAM-ICU positive was similar between groups (quetiapine 66.1 ± 76.4 msec vs. no quetiapine 44.1 ± 33.4 msec; p=0.173). Quetiapine was continued upon ICU and hospital discharge in 32% and 28% of patients, respectively.
Conclusions: Quetiapine administration was not associated with any benefits in delirium resolution. When initiated for ICU delirium, quetiapine was frequently continued beyond the hospital stay during medication reconciliation.