Liu Si Bo, Liu Shan, Gao Kai, Wu Guo Zhi, Zu Guo, Jie Liu Jin
Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China.
Department of Gastrointestinal Surgery, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China.
Ther Adv Psychopharmacol. 2023 Feb 20;13:20451253231152113. doi: 10.1177/20451253231152113. eCollection 2023.
As an atypical antipsychotic drug, olanzapine is one of the most commonly used drugs for delirium control. There are no systematic evaluations or meta-analyses of the efficacy and safety of olanzapine for delirium control in critically ill adults.
In this meta-analysis, we evaluated the efficacy and safety of olanzapine for delirium control in critically ill adults in the intensive care unit (ICU).
From inception to October 2022, 12 electronic databases were searched. We retrieved randomized controlled trials (RCTs) and retrospective cohort studies of critically ill adults with delirium that compared the effects of olanzapine and other interventions, including routine care (no intervention), nonpharmaceutical interventions and pharmaceutical interventions. The main outcome measures were the (a) relief of delirium symptoms and (b) a decrease in delirium duration. Secondary outcomes were ICU and in-hospital mortality, ICU and hospital length of stay, incidence of adverse events, cognitive function, sleep quality, quality of life, mechanical ventilation time, endotracheal intubation rate and delirium recurrence rate. We applied a random effects model.
Data from 10 studies (four RCTs and six retrospective cohort studies) involving 7076 patients (2459 in the olanzapine group and 4617 in the control group) were included. Olanzapine did not effectively relieve delirium symptoms (OR = 1.36, 95% CI [0.83, 2.28], = 0.21), nor did it shorten the duration of delirium [standardized mean difference (SMD) = 0.02, 95% CI [-1.04, 1.09], = 0.97] when compared with other interventions. Pooled data from three studies showed that the use of olanzapine reduced the incidence of hypotension (OR = 0.44, 95% CI [0.20, 0.95], = 0.04) compared with other pharmaceuticals. There was no significant difference in other secondary outcomes, including ICU or hospital length of stay, in-hospital mortality, extrapyramidal reactions, QTc interval prolongation, or overall incidence of other adverse reactions. The number of included studies was not sufficient for performing a comparison between olanzapine and no intervention.
Compared with other interventions, olanzapine has no advantage in alleviating delirium symptoms and shortening delirium duration in critically ill adults. However, there is some evidence that the rate of hypotension was lower in patients who received olanzapine than in those who received other pharmaceutical interventions. There was a nonsignificant difference in the length of ICU or hospital stay, in-hospital mortality, and other adverse reactions. This study provides reference data for delirium research and clinical drug intervention strategies in critically ill adults.
Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42021277232).
作为一种非典型抗精神病药物，奥氮平是控制谵妄最常用的药物之一。目前尚无关于奥氮平在危重症成年患者中控制谵妄疗效和安全性的系统评价或荟萃分析。
在这项荟萃分析中，我们评估了奥氮平在重症监护病房（ICU）危重症成年患者中控制谵妄的疗效和安全性。
从数据库建立至2022年10月，检索了12个电子数据库。我们检索了关于危重症成年谵妄患者的随机对照试验（RCT）和回顾性队列研究，这些研究比较了奥氮平与其他干预措施的效果，包括常规护理（无干预）、非药物干预和药物干预。主要结局指标为：（a）谵妄症状缓解；（b）谵妄持续时间缩短。次要结局包括ICU和住院死亡率、ICU和住院时间、不良事件发生率、认知功能、睡眠质量、生活质量、机械通气时间、气管插管率和谵妄复发率。我们采用随机效应模型。
纳入了10项研究（4项RCT和6项回顾性队列研究）的数据，涉及7076例患者（奥氮平组2459例，对照组4617例）。与其他干预措施相比，奥氮平未能有效缓解谵妄症状（OR = 1.36，95%CI [0.83, 2.28]，P = 0.21），也未缩短谵妄持续时间[标准化均数差（SMD）= 0.02，95%CI [-1.04, 1.09]，P = 0.97]。三项研究的汇总数据显示，与其他药物相比，使用奥氮平可降低低血压的发生率（OR = 0.44，95%CI [0.20, 0.95]，P = 0.04）。在其他次要结局方面，包括ICU或住院时间、住院死亡率、锥体外系反应、QTc间期延长或其他不良反应的总体发生率，均无显著差异。纳入的研究数量不足以进行奥氮平与无干预措施之间的比较。
与其他干预措施相比，奥氮平在缓解危重症成年患者谵妄症状和缩短谵妄持续时间方面并无优势。然而，有一些证据表明，接受奥氮平治疗的患者低血压发生率低于接受其他药物干预的患者。在ICU或住院时间、住院死亡率及其他不良反应方面，差异无统计学意义。本研究为危重症成年患者的谵妄研究和临床药物干预策略提供了参考数据。
系统评价前瞻性注册库（PROSPERO；注册号CRD42021277232）
