Efficacy of Low-Dose Prophylactic Quetiapine on Delirium Prevention in Critically Ill Patients: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

被引:6
|
作者
Kim, Youlim [1 ]
Kim, Hyung-Sook [2 ]
Park, Jong Sun [3 ]
Cho, Young-Jae [3 ]
Yoon, Ho Il [3 ]
Lee, Sang-Min [4 ]
Lee, Jae Ho [3 ]
Lee, Choon-Taek [3 ]
Lee, Yeon Joo [3 ]
机构
[1] Hallym Univ, Chuncheon Sacred Heart Hosp, Dept Internal Med, Div Pulm Allergy & Crit Care Med, Chuncheon Si 24253, Gangwon Do, South Korea
[2] Seoul Natl Univ, Bundang Hosp, Dept Pharm, Seongnam Si 13620, Gyeonggi Do, South Korea
[3] Seoul Natl Univ, Bundang Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Seongnam Si 13620, Gyeonggi Do, South Korea
[4] Seoul Natl Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Seoul 03080, South Korea
关键词
delirium; prevention; quetiapine; medical intensive care unit; extubation; INTENSIVE-CARE-UNIT; MECHANICALLY VENTILATED PATIENTS; TERM COGNITIVE IMPAIRMENT; HALOPERIDOL PROPHYLAXIS; POSTOPERATIVE DELIRIUM; ELDERLY-PATIENTS; RISK; MORTALITY; DURATION; SURGERY;
D O I
10.3390/jcm9010069
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Purpose: To evaluate the efficacy of short-term low-dose quetiapine for delirium prevention in critically ill patients. Methods: In this prospective, a single-center, randomized, double-blind, placebo-controlled trial, adult patients who were admitted from July 2015 to July 2017 to a medical intensive care unit (ICU) of a tertiary teaching hospital affiliated to Seoul National University were included. Quetiapine (12.5 mg or 25 mg oral at night; N = 16) or placebo (N = 21) was administered according to randomization until ICU discharge or the 10th ICU day. The primary endpoint was the incidence of delirium within the first 10 ICU days. Secondary endpoints included the rate of positive Confusion Assessment Method for the ICU (CAM-ICU) (the number of positive CAM-ICU counts/the number of total CAM-ICU counts), delirium duration, successful extubation, and overall mortality. Result: The incidence of delirium during the 10 days after ICU admission was 46.7% (7/15) in the quetiapine group and 55.0% (11/20) in the placebo group (p = 0.442). In the quetiapine group, the rate of positive CAM-ICU was significantly lower than in the placebo group (14.4% vs. 37.4%, p = 0.048), delirium duration during the study period was significantly shorter (0.28 day vs. 1.83 days, p = 0.018), and more patients in the quetiapine than in the placebo group were weaned from mechanical ventilation successfully (84.6% vs. 47.1%, p = 0.040). Conclusions: Our study suggests that prophylactic use of low-dose quetiapine could be helpful for preventing delirium in critically ill patients. A further large-scale prospective study is needed.
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页数:11
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