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The following is a summary of “Antipsychotics in the Treatment of Delirium in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” published in the March 2024 issue of Critical Care by Carayannopoulos et al.
Researchers conducted a retrospective study to assess how antipsychotic medications impact critical care patients with delirium by reviewing past research and statistically combining results.
They searched Ovid MEDLINE, EMBASE, APA PsycInfo, Wiley’s Cochrane Library, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (November 2023). Abstracts and titles were screened for eligibility, followed by a full-text screening of qualifying studies, both independently and in duplicate. Parallel-group RCTs involving critically ill adult patients with delirium were included. The intervention group got antipsychotics, while the control group got usual care or a placebo. Data was analyzed independently and in duplicate using a piloted form, and statistical analyses were done with RevMan software.
The results showed 5 RCTs (n = 1750) fulfilled the eligibility criteria. Antipsychotic medication use did not elevate the number of delirium- or coma-free days (mean difference 0.90 d; 95% CI, –0.32 to 2.12; moderate certainty). Disparities did not occur in death, mechanical ventilation time, hospital length of stay, or ICU. Administration of antipsychotics did not escalate the risk of adverse events (RR 1.27; 95% CI, 0.71–2.30; high certainty). Subgroup analysis comparing typical versus atypical antipsychotics did not unveil any subgroup effect for any outcome.
Investigators concluded that antipsychotics did not shorten delirium or coma duration in critically ill adults, but further study on patients with hyperactive delirium might be worthwhile.
Source: journals.lww.com/ccmjournal/abstract/9900/antipsychotics_in_the_treatment_of_delirium_in.304.aspx