Quetiapine in prolonged ICU delirium

Introduction

Delirium affects up to 33% of acutely hospitalized patients. In ICU patients it can prolong the length of stay and increase mortality [1]. The optimal management of delirium requires a calm environment, sleep hygiene and correction of underlying factors (for example, infection). This can be a challenge in the ICU, and drug therapy, commonly haloperidol, clonidine, benzodiazepines or propofol, is often used [1]. Quetiapine, an atypical antipsychotic, has been used in acute delirium outside the ICU [2]. It has few extrapyramidal side effects, a short half-life and is mildly sedating. Our impression was that it had potential in the treatment of delirium.

Methods

In a 30-bed tertiary ICU with more than 1,200 admissions annually we reviewed the notes of patients admitted from February 2008 to November 2009 who had a delirium treated with quetiapine. Patients were excluded if they were taking quetiapine prior to admission. The following data were recorded: Richmond Agitation and Sedation Score (RASS), duration of delirium, agents used, patient demographics and adverse events.

Results

Five patients met the inclusion criteria (Table 1). All were males, aged 37 to 85 years. All had a prolonged delirium prior to the commencement of quetiapine and all were on a combination of four drugs (clonidine, haloperidol, lorazepam and propofol) that were not controlling their delirium. At 3 to 7 days following commencement of quetiapine the RASS scores were 0 and other drugs were ceased. No adverse effects were noted.

Table 1

Conclusions

Quetiapine was successful in controlling prolonged ICU delirium and allowed weaning of other medications in these patients. It may be a useful delirium therapy. Further studies are required to demonstrate efficacy and safety.