Hui David, Reddy Akhila, Palla Shana, Bruera Eduardo
Department of Palliative Care and Rehabilitation, Medicine Unit 1414, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
J Palliat Care. 2011 Summer;27(2):141-7.
Neuroleptics are frequently used by palliative care specialists to treat delirium. In this study, we determined the median daily neuroleptic dose and prescription pattern in a cohort of unselected advanced cancer in-patients with delirium.
We retrospectively reviewed the charts of 100 consecutive patients admitted to our acute palliative care unit with delirium for demographics, delirium characteristics, and neuroleptic use during the first five days of delirium. The dose of neuroleptics was expressed using the concept of haloperidol equivalent daily dose (HEDD).
The median delirium duration was six days, and the median Memorial Delirium Assessment Scale on day 1 was 13/30. Subtypes of delirium included hypoactive (31 percent), mixed (59 percent), and hyperactive (10 percent). Haloperidol, olanzapine, and chlorpromazine were given to 94 (94 percent), 8 (8 percent), and 5 (5 percent) of patients, respectively. The median five-day average HEDD was 3.2 mg (interquartile range 1.5-6.0 mg). HEDD was not associated with any clinical characteristics except delirium subtype. Among the 31 occasions in which > or =3 breakthrough doses were given in a day, only 9 (29 percent) resulted in an increase in the scheduled neuroleptic dose, and 1 (3 percent) resulted in the addition of a new neuroleptic the next day. Among the 73 patients with 24 days of delirium, only 49 (67 percent) had an increase in the neuroleptic dose, and 2 (3 percent) had a new neuroleptic added.
HEDD was lower than doses reported in previous studies involving cancer patients and was adjusted sparingly. Prospective clinical trials are necessary to identify the optimal neuroleptic dose for delirium.
姑息治疗专家经常使用抗精神病药物来治疗谵妄。在本研究中，我们确定了一组未经挑选的患有谵妄的晚期癌症住院患者的每日抗精神病药物剂量中位数和处方模式。
我们回顾性分析了连续100例入住我们急性姑息治疗病房且患有谵妄的患者的病历，以了解其人口统计学特征、谵妄特点以及谵妄前五天内抗精神病药物的使用情况。抗精神病药物的剂量采用氟哌啶醇等效日剂量（HEDD）的概念来表示。
谵妄持续时间中位数为6天，第1天纪念谵妄评估量表中位数为13/30。谵妄亚型包括活动减退型（31%）、混合型（59%）和活动亢进型（10%）。分别有94例（94%）、8例（8%）和5例（5%）患者接受了氟哌啶醇、奥氮平和氯丙嗪治疗。五天平均HEDD中位数为3.2毫克（四分位间距1.5 - 6.0毫克）。除谵妄亚型外，HEDD与任何临床特征均无关联。在一天内给予≥3次突破剂量的31例情况中，只有9例（29%）导致计划的抗精神病药物剂量增加，1例（3%）导致次日添加了一种新的抗精神病药物。在73例谵妄持续24天的患者中，只有49例（67%）的抗精神病药物剂量增加，2例（3%）添加了新的抗精神病药物。
HEDD低于先前涉及癌症患者的研究中报告的剂量，且调整较少。有必要进行前瞻性临床试验以确定谵妄的最佳抗精神病药物剂量。
