Orlando Health, Orlando, FL, USA.
Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Intensive Care Med. 2020 Apr;35(4):394-399. doi: 10.1177/0885066617754187. Epub 2018 Jan 22.
To evaluate the efficacy and safety of lurasidone compared with quetiapine for treatment of delirium in critically ill patients.
Prospective, observational cohort study.
Single-center community teaching hospital.
Forty adult intensive care unit (ICU) patients with delirium (Confusion Assessment Method in the ICU positive), tolerating enteral nutrition, and without active alcohol withdrawal or prior use of atypical antipsychotics.
Patients were treated at the discretion of the prescriber with either lurasidone or quetiapine for delirium. Dose escalation and/or discontinuation were determined at the discretion of individual providers.
Baseline characteristics differed with a higher severity of illness in patients in the quetiapine group (n = 20) and a higher baseline QTc interval in the lurasidone group (n = 20). No significant difference was seen in the time to delirium resolution (3.2 vs 3.4 days), average daily haloperidol requirements (5.7 vs 6.9 mg), hospital length of stay (LOS; 23.6 vs 27.9 days), or ICU LOS (12.1 vs 14.2 days). Lurasidone was associated with fewer ventilator support days (4.0 [interquartile range, IQR: 2.3-6.8] days vs 7 [IQR: 4.0-9.8; = .0295] days) but also a fewer number of delirium-free days (0 [IQR: 0-1.0] days vs 2 [IQR: 0-3.0; = .0231] days). Additionally, no difference was seen for ICU mortality (20% vs 20%), percentage of time oversedated (2.8% vs 2.7%), or incidence of QTc prolongation (10.0% vs 10.0%).
Lurasidone for the treatment of delirium in critically ill patients did not differ in the time to delirium resolution when compared to quetiapine. Additionally, the incidence of QTc prolongation between agents does not appear to be different. Future randomized trials should evaluate dose escalation schemes and a larger proportion of patients to evaluate differences in mortality, efficacy, and life-threatening arrhythmias associated with atypical antipsychotic use.
评估鲁拉西酮与喹硫平治疗重症监护病房（ICU）患者谵妄的疗效和安全性。
前瞻性观察队列研究。
单中心社区教学医院。
40 名 ICU 有谵妄（ICU 意识模糊评估法阳性）、能耐受肠内营养、无酒精戒断活跃期且未使用过非典型抗精神病药物的成年患者。
根据医生的判断，患者使用鲁拉西酮或喹硫平治疗谵妄。剂量递增和/或停药由各个提供者决定。
基线特征不同，喹硫平组（n=20）患者的疾病严重程度更高，而鲁拉西酮组（n=20）的基线 QTc 间隔更长。在谵妄缓解时间（3.2 天 vs 3.4 天）、平均每日氟哌啶醇需求（5.7 毫克 vs 6.9 毫克）、住院时间（23.6 天 vs 27.9 天）或 ICU 住院时间（12.1 天 vs 14.2 天）方面均无显著差异。鲁拉西酮与更少的呼吸机支持天数（4.0[四分位距：2.3-6.8]天 vs 7[四分位距：4.0-9.8； =.0295]天）相关，但也与更少的谵妄无天数（0[四分位距：0-1.0]天 vs 2[四分位距：0-3.0； =.0231]天）相关。此外，两组 ICU 死亡率（20% vs 20%）、过度镇静时间比例（2.8% vs 2.7%）或 QTc 延长发生率（10.0% vs 10.0%）均无差异。
与喹硫平相比，鲁拉西酮治疗 ICU 患者谵妄在谵妄缓解时间方面没有差异。此外，两种药物的 QTc 延长发生率似乎没有差异。未来的随机试验应评估剂量递增方案和更大比例的患者，以评估与非典型抗精神病药物使用相关的死亡率、疗效和危及生命的心律失常的差异。
