Thielen Jessica R, Sawyer Jaclyn E, Henry Brandon M, Zebracki Jessica, Cooper David S, Koh Wonshill
The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229, USA.
Division of Pharmacy, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Cardiol. 2024 Mar;45(3):666-672. doi: 10.1007/s00246-022-02980-3. Epub 2022 Aug 7.
Opioids or benzodiazepines use is known to increase the risk of delirium. The prevalence of delirium is high in pediatric cardiac intensive care units (CICUs) with associated morbidity and mortality. We investigate the short-term effects of quetiapine, an atypical antipsychotic medication, on opioid and benzodiazepine requirements, and any associated adverse events as we utilize quetiapine to treat delirium symptoms in this single-center, retrospective study. Twenty-eight patients who received quetiapine between January 2018 and June 2019 in the CICU met inclusion criteria for the analysis. The quetiapine initiation dose was 0.5 mg/kg/dose every 8 h and we allowed 48 h for quetiapine to reach a steady state. Overall opioid and benzodiazepine requirements were compared 72 h before and 72 h after the quetiapine steady state. There was a statistically significant reduction in the total daily opioid (p = 0.001) and benzodiazepine (p = 0.01) amounts following quetiapine initiation. There was also a statistically significant decrease in the total number of daily PRNs requirement for both opioids (p < 0.001) and benzodiazepines (p = 0.03). Nine out of 13 patients were completely weaned off continuous opioid drips following quetiapine initiation (p = 0.01). The presence of steady-state habituation medications, including methadone or lorazepam, did not have any statistically significant effect on weaning continuous opioid (p = 0.18) or benzodiazepine (p = 0.62) drips. There was no statistically significant effect of quetiapine on the QTc interval after quetiapine initiation (p = 0.58) with no clinically significant arrhythmias observed during the study period. Our study demonstrates a statistically significant reduction in opioid and benzodiazepine requirements following quetiapine initiation to treat delirium symptoms without significant adverse effects in patients with congenital heart disease in the short term.
已知使用阿片类药物或苯二氮䓬类药物会增加谵妄风险。在儿科心脏重症监护病房（CICUs）中，谵妄的患病率很高，且伴有发病率和死亡率。在这项单中心回顾性研究中，我们调查了非典型抗精神病药物喹硫平对阿片类药物和苯二氮䓬类药物需求的短期影响，以及使用喹硫平治疗谵妄症状时的任何相关不良事件。2018年1月至2019年6月期间在CICU接受喹硫平治疗的28例患者符合纳入分析标准。喹硫平起始剂量为每8小时0.5mg/kg/剂量，我们让喹硫平48小时达到稳态。在喹硫平达到稳态前72小时和达到稳态后72小时比较了阿片类药物和苯二氮䓬类药物的总体需求。开始使用喹硫平后，每日阿片类药物总量（p = 0.001）和苯二氮䓬类药物总量（p = 0.01）有统计学显著降低。阿片类药物（p < 0.001）和苯二氮䓬类药物（p = 0.03）每日按需给药的总数也有统计学显著减少。开始使用喹硫平后，13例患者中有9例完全停用了持续静脉滴注的阿片类药物（p = 0.01）。包括美沙酮或劳拉西泮在内的稳态习惯性药物的存在对停用持续静脉滴注的阿片类药物（p = 0.18）或苯二氮䓬类药物（p = 0.62）没有任何统计学显著影响。开始使用喹硫平后，喹硫平对QTc间期没有统计学显著影响（p = 0.58），在研究期间未观察到具有临床意义的心律失常。我们的研究表明，在先天性心脏病患者中，开始使用喹硫平治疗谵妄症状后，阿片类药物和苯二氮䓬类药物的需求有统计学显著降低，且短期内无明显不良反应。
