Kishk Omayma A, Simone Shari, Lardieri Allison B, Graciano Ana Lia, Tumulty Jamie, Edwards Sarah
J Pediatr Pharmacol Ther. 2019 May-Jun;24(3):204-213. doi: 10.5863/1551-6776-24.3.204.
To describe the use of pharmacologic treatment in critically ill children treated according to a delirium protocol and compare those treated with antipsychotics to those treated non-pharmacologically.
METHODS>: The study included a retrospective matched cohort describing patients who were pharmacologically treated for delirium compared to those with delirium but not treated in a PICU from December 2013 to September 2015, using a delirium management protocol. Patients were matched by age, sex, diagnosis, mechanical ventilation (MV), and presence of delirium.
Of 1875 patients screened, 188 (10.03%) were positive for delirium. Of those, 15 patients (8%) were treated with an antipsychotic for delirium. Patients with delirium treated with antipsychotics were younger, had more delirium days (6 vs. 3, p=0.022), longer MV days (14 vs. 7, p=0.017), and longer PICU length of stay (34 vs. 16 days, p=0.029) than in the untreated group. Haloperidol, risperidone, and quetiapine were used in 9, 6, and 2 patients, respectively. Two patients were treated with multiple antipsychotics. Antipsychotic treatment was initiated on day 2 of delirium for 8 of 15 patients (53.3%). Ten patients in the treatment group had improved delirium scores by day 2 of treatment. No significant differences in sedation exposure between groups. No significant adverse effects were reported.
No significant adverse events seen in this small cohort of critically ill pediatric patients with delirium treated with antipsychotic therapy. Patients with early-onset delirium refractory to non-pharmacologic treatment may have a more effective response to antipsychotic therapy than patients with late-onset refractory delirium.
描述在按照谵妄治疗方案治疗的危重症儿童中药物治疗的使用情况，并比较使用抗精神病药物治疗的患者与非药物治疗的患者。
该研究纳入了一个回顾性匹配队列，描述了2013年12月至2015年9月期间因谵妄接受药物治疗的患者与在儿科重症监护病房（PICU）中患有谵妄但未接受治疗的患者，采用谵妄管理方案。患者按年龄、性别、诊断、机械通气（MV）和谵妄的存在情况进行匹配。
在1875名筛查的患者中，188名（10.03%）谵妄呈阳性。其中，15名患者（8%）因谵妄接受了抗精神病药物治疗。与未治疗组相比，接受抗精神病药物治疗的谵妄患者更年轻，谵妄天数更多（6天对3天，p = 0.022），机械通气天数更长（14天对7天，p = 0.017），儿科重症监护病房住院时间更长（34天对16天，p = 0.029）。分别有9名、6名和2名患者使用了氟哌啶醇、利培酮和喹硫平。两名患者接受了多种抗精神病药物治疗。15名患者中有8名（53.3%）在谵妄第2天开始使用抗精神病药物治疗。治疗组中有10名患者在治疗第2天谵妄评分有所改善。两组之间镇静暴露无显著差异。未报告显著不良反应。
在这一小群接受抗精神病药物治疗的患有谵妄的危重症儿科患者中未观察到显著不良事件。与迟发性难治性谵妄患者相比，非药物治疗难治的早发性谵妄患者可能对抗精神病药物治疗反应更有效。
