University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, PA, USA.
University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
J Crit Care. 2017 Oct;41:234-239. doi: 10.1016/j.jcrc.2017.05.034. Epub 2017 Jun 1.
Conflicting data exists on the efficacy of antipsychotics for treatment of intensive care unit (ICU) delirium. The purpose of this study was to compare time to delirium resolution for ICU patients who were managed with and without antipsychotics.
This retrospective cohort evaluation included patients admitted to 12 ICUs at 5 sites over 5 weeks diagnosed with delirium. The primary outcome was time to delirium resolution. Secondary outcomes included ICU length of stay (LOS), mortality, discharge disposition and delirium redevelopment. A Cox proportional hazards model explored the relationship between covariates including antipsychotics and time to delirium resolution.
A total of 255 patients met inclusion criteria; 69 (27%) received antipsychotics. In the antipsychotic group, time to resolution of delirium was longer (Median: 36hours vs. 13hours, p<0.001) and ICU LOS was longer (Median: 5.9days vs. 3.8days, p=0.005), but there were no differences in mortality or discharge disposition. Patients who used antipsychotics (HR=0.512; 95% CI: 0.276-0.952) and received mechanical ventilation (HR=0.381; 95% CI: 0.217-0.669) had slower rate for time to delirium resolution.
While the treatment of delirium with antipsychotics remains common, antipsychotics were not associated with a shorter time to resolution of delirium.
抗精神病药治疗重症监护病房（ICU）谵妄的疗效存在矛盾的数据。本研究的目的是比较接受和不接受抗精神病药治疗的 ICU 患者谵妄缓解的时间。
本回顾性队列评估纳入了在 5 个地点的 12 个 ICU 中，在 5 周内被诊断为谵妄的患者。主要结局是谵妄缓解的时间。次要结局包括 ICU 住院时间（LOS）、死亡率、出院去向和谵妄再发。Cox 比例风险模型探讨了包括抗精神病药在内的协变量与谵妄缓解时间之间的关系。
共有 255 名患者符合纳入标准；69 名（27%）接受了抗精神病药。在抗精神病药组，谵妄缓解的时间更长（中位数：36 小时 vs. 13 小时，p<0.001），ICU LOS 更长（中位数：5.9 天 vs. 3.8 天，p=0.005），但死亡率或出院去向无差异。使用抗精神病药的患者（HR=0.512；95%CI：0.276-0.952）和接受机械通气的患者（HR=0.381；95%CI：0.217-0.669）的谵妄缓解时间较慢。
尽管使用抗精神病药治疗谵妄仍然很常见，但抗精神病药与谵妄缓解时间的缩短无关。
