Pharmacy Department, Surrey Memorial Hospital, Surrey, BC, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
J Clin Pharm Ther. 2021 Jun;46(3):669-676. doi: 10.1111/jcpt.13319. Epub 2020 Dec 5.
Delirium has been associated with increased mortality and prolonged hospital length of stay among critical care patients. Furthermore, treatment of delirium remains variable amongst clinicians due to limited evidence. The objective of this study was to determine the local incidence of delirium and to characterize the effectiveness and safety of pharmacological therapy used to treat delirium.
A retrospective chart review evaluated patients diagnosed with delirium (Intensive Care Delirium Screening Checklist score ≥4) and requiring mechanical ventilation for ≥48 hours from January 2016 to June 2017. The primary outcomes included comparison of resolution, the time to first resolution and recurrence of delirium in patients prescribed pharmacological and/or pre-emptive therapy versus those who did not. Secondary outcomes included incidence of adverse effects of drug therapy and delirium attributable adverse events.
The incidence of delirium during our defined study period was 49%. Of the 178 patients included in the study, 136 (76%) received drug therapy for delirium. Agents used for treatment of delirium included dexmedetomidine (n = 90 [66%]), haloperidol (n = 77 [57%]), and quetiapine (n = 74 [54%]). Resolution of delirium occurred in 94 (52%) of patients and the difference was statistically significant favoring patients who did not receive pharmacological therapy. There was no difference in the median time to resolution of delirium (3 days) for patients who received pharmacological and/or pre-emptive therapy versus those who did not. Bradycardia and hypotension were the most frequently documented medication-related adverse events. Self-removal of an invasive line/catheter, was reported in 36 (26%) patients despite receiving pharmacological treatment.
Despite unclear evidence that pharmacological interventions help with delirium management, the majority of our patients received such interventions. To improve patient outcomes, we should shift focus towards non-pharmacological interventions for delirium.
在重症监护患者中，谵妄与死亡率增加和住院时间延长有关。此外，由于证据有限，治疗谵妄的方法在临床医生中仍存在差异。本研究的目的是确定谵妄的当地发病率，并描述用于治疗谵妄的药物治疗的有效性和安全性。
回顾性图表审查评估了 2016 年 1 月至 2017 年 6 月期间被诊断为谵妄（密集护理谵妄筛查检查表评分≥4）并需要机械通气≥48 小时的患者。主要结果包括比较接受药物和/或预防治疗的患者与未接受治疗的患者的谵妄缓解情况、首次缓解时间和复发情况。次要结果包括药物治疗的不良反应发生率和与谵妄相关的不良反应发生率。
在我们定义的研究期间，谵妄的发生率为 49%。在研究中纳入的 178 名患者中，136 名（76%）接受了治疗谵妄的药物治疗。用于治疗谵妄的药物包括右美托咪定（n=90[66%]）、氟哌啶醇（n=77[57%]）和喹硫平（n=74[54%]）。94 名（52%）患者的谵妄得到缓解，差异有统计学意义，有利于未接受药物治疗的患者。接受药物和/或预防治疗的患者与未接受治疗的患者的谵妄缓解中位时间无差异（3 天）。最常记录的药物相关不良事件是心动过缓和低血压。尽管接受了药物治疗，但仍有 36 名（26%）患者自行拔出侵入性线路/导管。
尽管药物干预有助于管理谵妄的证据尚不明确，但我们的大多数患者仍接受此类干预。为了改善患者的预后，我们应该将重点转移到非药物干预上。
