Johns Hopkins University School of Medicine, Baltimore, Maryland (R.N., K.J.N., E.S.O., K.A.R., D.M.N.).
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (L.M.W., A.Z.).
Ann Intern Med. 2019 Oct 1;171(7):485-495. doi: 10.7326/M19-1860. Epub 2019 Sep 3.
Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear.
To conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults.
PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception to July 2019 without language restrictions.
Randomized controlled trials (RCTs) of antipsychotic versus placebo or another antipsychotic, and prospective observational studies reporting harms.
One reviewer extracted data and assessed strength of evidence (SOE) for critical outcomes, with confirmation by another reviewer. Risk of bias was assessed independently by 2 reviewers.
Across 16 RCTs and 10 observational studies of hospitalized adults, there was no difference in sedation status (low and moderate SOE), delirium duration, hospital length of stay (moderate SOE), or mortality between haloperidol and second-generation antipsychotics versus placebo. There was no difference in delirium severity (moderate SOE) and cognitive functioning (low SOE) for haloperidol versus second-generation antipsychotics, with insufficient or no evidence for antipsychotics versus placebo. For direct comparisons of different second-generation antipsychotics, there was no difference in mortality and insufficient or no evidence for multiple other outcomes. There was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently.
Heterogeneity was present in terms of dose and administration route of antipsychotics, outcomes, and measurement instruments. There was insufficient or no evidence regarding multiple clinically important outcomes.
Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.
Agency for Healthcare Research and Quality. (PROSPERO: CRD42018109552).
谵妄在住院患者中很常见，并且与更差的预后相关。抗精神病药常用于治疗谵妄；然而，其相关的益处和危害尚不清楚。
系统评价评估抗精神病药治疗成人谵妄的益处和危害。
从建库至 2019 年 7 月，检索 PubMed、Embase、CENTRAL、CINAHL 和 PsycINFO，无语言限制。
抗精神病药与安慰剂或另一种抗精神病药比较的随机对照试验（RCT），以及报告危害的前瞻性观察性研究。
一名评审员提取数据并评估关键结局的证据强度（SOE），另一名评审员进行确认。两名评审员独立评估偏倚风险。
纳入 16 项 RCT 和 10 项关于住院成人的观察性研究，与安慰剂相比，氟哌啶醇和第二代抗精神病药在镇静状态（低和中 SOE）、谵妄持续时间、住院时间（中 SOE）或死亡率方面无差异。氟哌啶醇与第二代抗精神病药在谵妄严重程度（中 SOE）和认知功能（低 SOE）方面无差异，抗精神病药与安慰剂相比，证据不足或无。对于不同第二代抗精神病药的直接比较，死亡率方面无差异，其他多个结局的证据不足或无。短期使用抗精神病药治疗住院成人谵妄与神经相关危害的证据很少，但心脏相关潜在有害作用更常见。
抗精神病药的剂量和给药途径、结局和测量工具方面存在异质性。多个重要结局缺乏或没有证据。
目前的证据不支持常规使用氟哌啶醇或第二代抗精神病药治疗住院成人谵妄。
美国卫生保健研究与质量局（PROSPERO：CRD42018109552）。
