Ernest Mario School of Pharmacy, Rutgers,The State University of New Jersey, Piscataway, NJ,USA.
Mount Sinai Hospital, New York, NY,USA.
Am J Health Syst Pharm. 2021 Jul 22;78(15):1385-1394. doi: 10.1093/ajhp/zxab180.
Nearly half of intensive care unit (ICU) patients will develop delirium. Antipsychotics are used routinely for the management of ICU delirium despite limited reliable data supporting this approach. The unwarranted continuation of antipsychotics initiated for ICU delirium is an emerging transitions of care concern, especially considering the adverse event profile of these agents. We sought to evaluate the magnitude of this issue across 6 centers in New Jersey and describe risk factors for continuation.
This multicenter, retrospective study examined adult ICU patients who developed ICU delirium from June 2016 to June 2018. Patients were included in the study if they received at least 3 doses of antipsychotics while in the ICU with presence of either a clinical diagnosis of delirium or a positive Confusion Assessment Method score. Patients were excluded if they were on an antipsychotic before ICU admission.
Of the 300 patients included and initiated on antipsychotics for ICU delirium, 157 (52.3%) were continued on therapy upon transfer from the ICU to another level of inpatient care. The number of patients continued on newly initiated antipsychotics further increased to 183 (61%) upon discharge from the hospital.
The continuation of antipsychotics for the management of delirium during transitions of care was a common practice across ICUs in New Jersey. Several risk factors for continuation of antipsychotics were identified. Efforts to reduce unnecessary continuation of antipsychotics at transitions of care are warranted.
近一半的重症监护病房（ICU）患者会出现谵妄。尽管支持这种方法的可靠数据有限，但抗精神病药仍被常规用于 ICU 谵妄的治疗。在 ICU 谵妄中不合理地继续使用抗精神病药是一个新出现的过渡护理问题，尤其是考虑到这些药物的不良事件概况。我们试图在新泽西州的 6 个中心评估这个问题的严重程度，并描述继续使用的风险因素。
这项多中心回顾性研究检查了 2016 年 6 月至 2018 年 6 月期间在 ICU 发生 ICU 谵妄的成年 ICU 患者。如果患者在 ICU 期间接受了至少 3 剂抗精神病药，并且存在临床诊断的谵妄或阳性意识混乱评估方法评分，则将其纳入研究。如果患者在入住 ICU 之前正在使用抗精神病药，则将其排除在外。
在 300 名因 ICU 谵妄而开始接受抗精神病药治疗的患者中，有 157 名（52.3%）在从 ICU 转入其他住院治疗水平时继续接受治疗。在出院时，新开始使用抗精神病药的患者数量进一步增加到 183 名（61%）。
在过渡护理期间，为管理谵妄而继续使用抗精神病药是新泽西州各 ICU 的常见做法。确定了继续使用抗精神病药的几个风险因素。有必要努力减少过渡护理期间不必要的抗精神病药继续使用。
