Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, M/S FA2.112, 4800 Sand Point Way NE, Seattle, WA, USA.
Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, USA.
Paediatr Drugs. 2021 Mar;23(2):159-169. doi: 10.1007/s40272-021-00437-3. Epub 2021 Feb 26.
The aim of this study was to evaluate outcomes of pediatric intensive care unit (PICU) patients with delirium treated with haloperidol or quetiapine compared with propensity-matched, untreated patients.
A single-center retrospective cohort study was conducted including PICU admissions of ≥ 48 h for children ≥ 2 months old with a positive delirium screening score (Cornell Assessment of Pediatric Delirium ≥ 9). We generated propensity scores for the likelihood of receiving treatment with haloperidol or quetiapine using logistic regression, and matched untreated to treated patients 2:1 to compare outcomes between groups.
Among 846 eligible admissions, 27 were treated with haloperidol or quetiapine (3.2%). Time to first delirium-free score was similar for treated versus untreated patients. Treated patients had no significant change in delirium scores following treatment, while untreated patients' scores improved after the comparable matching time. Compared with untreated patients, haloperidol-treated patients had more subsequent days of delirium and exposure to neuromuscular blockade. Quetiapine-treated patients had more subsequent days of mechanical ventilation and exposure to neuromuscular blockade, longer PICU length of stay, and higher likelihood of functional decline at ICU discharge.
In our small, single-center study, patients treated with haloperidol or quetiapine showed no short-term improvement in delirium screening scores after starting treatment when compared with untreated, propensity score-matched patients. In addition, clinical outcomes were not improved or were worse among treated patients. A prospective trial is needed to evaluate whether antipsychotic medications benefit PICU patients with delirium.
本研究旨在评估与未接受治疗的、经倾向评分匹配的患儿相比，接受氟哌啶醇或喹硫平治疗的儿科重症监护病房（PICU）患儿谵妄的治疗结局。
本研究为单中心回顾性队列研究，纳入年龄≥2 个月、PICU 入住时间≥48 h 且阳性谵妄筛查评分（Cornell 儿童谵妄评估量表评分≥9 分）的患儿。我们采用逻辑回归生成接受氟哌啶醇或喹硫平治疗的可能性倾向评分，并按照 2:1 的比例将未接受治疗的患儿与接受治疗的患儿进行匹配，以比较两组患儿的结局。
在 846 例符合条件的入院患儿中，有 27 例接受了氟哌啶醇或喹硫平治疗（3.2%）。治疗组与未治疗组患儿达到首次谵妄评分正常的时间无显著差异。治疗后，治疗组患儿的谵妄评分无显著变化，而匹配时间后，未治疗组患儿的评分有所改善。与未治疗组患儿相比，氟哌啶醇治疗组患儿的谵妄天数和神经肌肉阻滞剂暴露天数更多，机械通气天数和神经肌肉阻滞剂暴露天数更多，PICU 住院时间更长，且 ICU 出院时发生功能下降的可能性更高。
在我们的小型单中心研究中，与未接受治疗、经倾向评分匹配的患儿相比，接受氟哌啶醇或喹硫平治疗的患儿在开始治疗后，其谵妄筛查评分并无短期改善。此外，治疗组患儿的临床结局并未改善，甚至更差。需要开展前瞻性试验来评估抗精神病药物是否有益于患有谵妄的 PICU 患儿。
