Menozzi Alessandro, Gotti Miriam, Mantovani Elena Alessandra, Galimberti Andrea, Umbrello Michele, Mistraletti Giovanni, Sabbatini Giovanni, Pezzi Angelo, Formenti Paolo
School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy.
Struttura Complessa Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy.
J Clin Med. 2025 Apr 18;14(8):2798. doi: 10.3390/jcm14082798.
Delirium is a frequent complication in critically ill patients, often leading to worse clinical outcomes, prolonged ICU stays, and an increased healthcare burden. Its identification has become more consistent with the adoption of validated diagnostic tools, allowing clinicians to recognize and address this condition more effectively. Although delirium can arise from direct neurological dysfunction, it is frequently a consequence of systemic conditions such as sepsis or organ failure. Therefore, a comprehensive evaluation of underlying causes is essential before initiating pharmacological treatment. Among the pharmacological options, quetiapine has gained attention for its use in ICU patients with delirium. Compared to first-generation antipsychotics, it is often preferred due to its sedative effects and more favorable safety. However, current clinical guidelines remain inconclusive regarding its routine use, as evidence supporting its efficacy is limited. One of the main challenges is the heterogeneity of patient populations included in randomized trials, making it difficult to determine whether specific subgroups may benefit more from treatment. This narrative review explores the pharmacological properties of quetiapine, its potential role in managing ICU delirium, and the current state of evidence regarding its safety and effectiveness.
谵妄是危重症患者常见的并发症，常导致更差的临床结局、延长重症监护病房（ICU）住院时间并增加医疗负担。随着采用经过验证的诊断工具，其识别变得更加一致，使临床医生能够更有效地识别和处理这种情况。虽然谵妄可能由直接的神经功能障碍引起，但它通常是脓毒症或器官衰竭等全身性疾病的结果。因此，在开始药物治疗之前，对潜在病因进行全面评估至关重要。在药物选择中，喹硫平因其在ICU谵妄患者中的应用而受到关注。与第一代抗精神病药物相比，由于其镇静作用和更有利的安全性，它通常更受青睐。然而，目前的临床指南对于其常规使用仍无定论，因为支持其疗效的证据有限。主要挑战之一是随机试验中纳入的患者群体的异质性，这使得难以确定特定亚组是否可能从治疗中获益更多。本叙述性综述探讨了喹硫平的药理特性、其在管理ICU谵妄中的潜在作用以及关于其安全性和有效性的现有证据状况。
