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Author Serafim, Rodrigo B. ♦ Bozza, Fernando A. ♦ Soares, Marcio ♦ Do Brasil, Pedro Emanuel A. A. ♦ Tura, Bernardo R. ♦ Ely, E. Wesley ♦ Salluh, Jorge I. F.
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Elsevier
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Social sciences ♦ Social problems & services; associations ♦ Social welfare problems & services ♦ Natural sciences & mathematics ♦ Chemistry & allied sciences ♦ Life sciences; biology ♦ Biochemistry ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Pharmacology and therapeutics ♦ Diseases ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Eukaryota ♦ Organisms ♦ Nervous System Diseases ♦ Pathological Conditions, Signs and Symptoms ♦ Diseases ♦ Organic Chemicals ♦ Heterocyclic Compounds ♦ Chemical Actions and Uses ♦ Chemicals and Drugs ♦ Diagnosis ♦ Therapeutics ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment ♦ Health Care Facilities, Manpower, and Services ♦ Health Care
Subject Keyword Discipline Critical Care ♦ Antipsychotic Agents ♦ Therapeutic Use ♦ Delirium ♦ Prevention & Control ♦ Hypnotics And Sedatives ♦ Neuroprotective Agents ♦ Postoperative Complications ♦ Critical Care ♦ Critical Illness ♦ Drug Therapy ♦ Dexmedetomidine ♦ Haloperidol ♦ Humans ♦ Hydroxymethylglutaryl-coa Reductase Inhibitors ♦ Intensive Care Units ♦ Length Of Stay ♦ Statistics & Numerical Data ♦ Quetiapine Fumarate ♦ Respiration, Artificial ♦ Risperidone ♦ Rivastigmine ♦ Treatment Outcome ♦ Journal Article ♦ Review
Abstract PURPOSE: The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. MATERIALS AND METHODS: We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. RESULTS: From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001). CONCLUSION: The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
Description Author Affiliation: Serafim RB ( D'Or Institute for Research and Education, Rio de Janeiro, Brazil); Bozza FA ( D'Or Institute for Research and Education, Rio de Janeiro, Brazil); Soares M ( D'Or Institute for Research and Education, Rio de Janeiro, Brazil); do Brasil PE ( D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: pedro.brasil@idor.org.); Tura BR ( D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: tura@centroin.com.br.); Ely EW ( Vanderbilt University School of Medicine, Nashville, TN, USA); Salluh JI ( D'Or Institute for Research and Education, Rio de Janeiro, Brazil)
ISSN 08839441
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2015-08-01
Publisher Place United States
e-ISSN 15578615
Journal Journal of Critical Care
Volume Number 30
Issue Number 4


Source: WHO-Global Index Medicus