Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Bone Marrow Transplantation and Hematologic Malignancies Program, Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Intensive Care Med. 2022 Feb;37(2):222-230. doi: 10.1177/0885066620984450. Epub 2021 Jan 11.
Intravenous (IV) olanzapine could be an alternative to first-generation antipsychotics for the management of agitation in intensive care unit (ICU) patients. We compared the effectiveness and safety of IV olanzapine to IV haloperidol for agitation management in adult patients in the ICU at a tertiary academic medical center.
A retrospective cohort study was conducted. The primary outcome was the proportion of patients who achieved a Richmond Agitation Sedation Scale (RASS) score of < +1 within 4 hours of IV olanzapine or IV haloperidol administration. Secondary outcomes included the proportion of patients who required rescue medications for agitation within 4 hours of initial IV olanzapine or IV haloperidol administration, incidence of adverse events and ICU length of stay.
In the 192 patient analytic cohort, there was no difference in the proportion of patients who achieved a RASS score of < +1 within 4 hours of receiving IV olanzapine or IV haloperidol (49% vs. 42%, p = 0.31). Patients in the IV haloperidol group were more likely to receive rescue medications (28% vs 55%, p < 0.01). There was no difference in the incidence of respiratory events or hypotension between IV olanzapine and IV haloperidol. Patients in the IV olanzapine group experienced more bradycardia (11% vs. 3%, p = 0.04) and somnolence (9% vs. 1%, p = 0.02) compared to the IV haloperidol group. Patients in the IV olanzapine group had a longer median ICU length of stay (7.5 days vs. 5 days, p = 0.04).
In this retrospective cohort study, there was no difference in the effectiveness of IV olanzapine compared to IV haloperidol for the management of agitation. IV olanzapine was associated with an increased incidence of bradycardia and somnolence.
静脉注射（IV）奥氮平可能是替代第一代抗精神病药治疗重症监护病房（ICU）患者激越的一种选择。我们比较了 IV 奥氮平与 IV 氟哌啶醇治疗三级学术医疗中心 ICU 成人患者激越的有效性和安全性。
进行了一项回顾性队列研究。主要结局是在接受 IV 奥氮平或 IV 氟哌啶醇治疗后 4 小时内，达到 Richmond 激越镇静量表（RASS）评分＜+1 的患者比例。次要结局包括在接受 IV 奥氮平或 IV 氟哌啶醇初始治疗后 4 小时内需要使用抗激越药物的患者比例、不良事件发生率和 ICU 住院时间。
在 192 例患者分析队列中，接受 IV 奥氮平或 IV 氟哌啶醇治疗后 4 小时内达到 RASS 评分＜+1 的患者比例无差异（49% vs. 42%，p=0.31）。IV 氟哌啶醇组患者更有可能需要使用抢救药物（28% vs. 55%，p＜0.01）。IV 奥氮平和 IV 氟哌啶醇之间的呼吸事件或低血压发生率无差异。IV 奥氮平组患者心动过缓（11% vs. 3%，p=0.04）和嗜睡（9% vs. 1%，p=0.02）的发生率高于 IV 氟哌啶醇组。IV 奥氮平组患者 ICU 住院时间中位数较长（7.5 天 vs. 5 天，p=0.04）。
在这项回顾性队列研究中，IV 奥氮平与 IV 氟哌啶醇治疗激越的效果无差异。IV 奥氮平与心动过缓和嗜睡发生率增加有关。
