Are dexmedetomidine and olanzapine suitable to control delirium in critically ill elderly patients? A retrospective cohort study

被引：12

作者：

Liu, SiBo ^{[1
,2
]}

Zhao, Rui ^{[2
]}

Yang, RongLi ^{[2
]}

Zhao, HongLing ^{[3
]}

Ji, ChenHua ^{[4
]}

Duan, MeiLi ^{[1
]}

Liu, JinJie ^{[3
]}

机构：

[1] Capital Med Univ, Beijing Friendship Hosp, Intens Care Unit, Beijing 100050, Peoples R China

[2] Dalian Municipal Cent Hosp, Intens Care Unit, Dalian 116033, Peoples R China

[3] Dalian Municipal Cent Hosp, Neurol Ward, Dalian 116033, Peoples R China

[4] Dalian Municipal Cent Hosp, 2 Gen Med Ward, Dalian 116033, Peoples R China

来源：

BIOMEDICINE & PHARMACOTHERAPY | 2021年 / 139卷

关键词：

Dexmedetomidine; Olanzapine; Delirium; Critical illness; Intensive care unit; Drug-related side effects and adverse reactions; CARDIAC-SURGERY; CARE; MANAGEMENT; HALOPERIDOL; PREVENTION; SEDATION; ICU; INTERVENTIONS; GUIDELINES; REDUCTION;

D O I：

10.1016/j.biopha.2021.111617

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

Background: The efficacy and safety of dexmedetomidine and olanzapine for delirium control in critically ill elderly patients without ventilation or surgery are not known. Methods: The efficacy and safety of dexmedetomidine and olanzapine for controlling delirium were evaluated in a retrospective cohort of critically illness by assessing the sedation level, drug dose/duration, combination rate with other sedatives, adverse effects, intubation rate and prognosis. Result: The maximum (1.61 +/- 1.56 vs. 2.70 +/- 1.01, p < 0.001), average (-0.57 +/- 0.88 vs. 0.88 +/- 0.73, p < 0.001), and minimum (-1.67 +/- 1.04 vs. -1.37 +/- 1.01, p = 0.014) RASS scores of 263 patients were lower after treating with dexmedetomidine than treating with olanzapine. Drug use duration (4.83 +/- 2.67 days vs. 5.87 +/- 3.14 days, p = 0.005) and sedative combination rates (13.56% vs. 40.00%, p = 0.003) were lower when treating with dexmedetomidine than that with olanzapine. A comparison of adverse effects between dexmedetomidine and olanzapine revealed respiratory depression (16.95% vs. 2.84%, p < 0.001), hypoxia (13.56% vs. 2.76%, p < 0.001) and hypotension (11.02% vs. 3.45%, p = 0.007). Intubation rates (22.88% vs. 12.41%, p = 0.023) and the length of hospital stay (9.30 +/- 4.90 days vs. 8.83 +/- 3.34 days, p < 0.001) were higher in patients treated with dexmedetomidine than that with olanzapine. Mortality rates, cognitive prognosis, and delirium recurrence rates were similar between groups. Age, severe cardiopulmonary disease, APACHE II scores, dexmedetomidine dose, minimum RASS score and sedative combination were significantly (p < 0.05) associated with the adverse effects of dexmedetomidine. Respiratory depression, hypoxia and hypotension in the olanzapine group all occurred during combination with benzodiazepines. Conclusions: Dexmedetomidine achieved more satisfactory sedative effects on delirium control, but olanzapine was safer.

引用

页数：8

共 34 条

[1] ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE) II SCORE - THE CLINICAL PREDICTOR IN NEUROSURGICAL INTENSIVE CARE UNIT [J].

Akavipat, Phuping ;

Thinkhamrop, Jadsada ;

Thinkhamrop, Bandit ;

Sriraj, Wimonrat .

ACTA CLINICA CROATICA, 2019, 58 (01) :50-56

[2] Randomized ICU Trials Do Not Demonstrate an Association Between Interventions That Reduce Delirium Duration and Short-Term Mortality: A Systematic Review and Meta-Analysis [J].

Al-Qadheeb, Nada S. ;

Balk, Ethan M. ;

Fraser, Gilles L. ;

Skrobik, Yoanna ;

Riker, Richard R. ;

Kress, John P. ;

Whitehead, Shawn ;

Devlin, John W. .

CRITICAL CARE MEDICINE, 2014, 42 (06) :1442-1454

[3]

Arbanas G, 2015, DIAGNOSTIC STAT MANU

[4] Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety [J].

Barends, Clemens R. M. ;

Absalom, Anthony ;

van Minnen, Baucke ;

Vissink, Arjan ;

Visser, Anita .

PLOS ONE, 2017, 12 (01)

[5] Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit [J].

Barr, Juliana ;

Fraser, Gilles L. ;

Puntillo, Kathleen ;

Ely, E. Wesley ;

Gelinas, Celine ;

Dasta, Joseph F. ;

Davidson, Judy E. ;

Devlin, John W. ;

Kress, John P. ;

Davidson, Judy E. ;

Devlin, John W. ;

Kress, John P. ;

Joffe, Aaron M. ;

Coursin, Douglas B. ;

Herr, Daniel L. ;

Tung, Avery ;

Robinson, Bryce R. H. ;

Fontaine, Dorrie K. ;

Ramsay, Michael A. ;

Riker, Richard R. ;

Sessler, Curtis N. ;

Pun, Brenda ;

Skrobik, Yoanna ;

Jaeschke, Roman .

CRITICAL CARE MEDICINE, 2013, 41 (01) :263-306

[6] Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: A comparison of efficacy, safety, and side effects [J].

Boettger, Soenke ;

Jenewein, Josef ;

Breitbart, William .

PALLIATIVE & SUPPORTIVE CARE, 2015, 13 (04) :1079-1085

[7] Antipsychotics for treatment of deliriumin hospitalised non-ICU patients [J].

Burry, Lisa ;

Mehta, Sangeeta ;

Perreault, Marc M. ;

Luxenberg, Jay S. ;

Siddiqi, Najma ;

Hutton, Brian ;

Fergusson, Dean A. ;

Bell, Chaim ;

Rose, Louise .

COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2018, (06)

[8]

Devlin JW, 2018, CRIT CARE MED, V46, P1532, DOI [10.1097/CCM.0000000000003299, 10.1097/CCM.0000000000003259]

[9] Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery A Randomized Controlled Trial [J].

Djaiani, George ;

Silverton, Natalie ;

Fedorko, Ludwik ;

Carroll, Jo ;

Styra, Rima ;

Rao, Vivek ;

Katznelson, Rita .

ANESTHESIOLOGY, 2016, 124 (02) :362-368

[10] Monitoring sedation status over time in ICU patients - Reliability and validity of the Richmond Agitation-Sedation Scale (RASS) [J].

Ely, EW ;

Truman, B ;

Shintani, A ;

Thomason, JWW ;

Wheeler, AP ;

Gordon, S ;

Francis, J ;

Speroff, T ;

Gautam, S ;

Margolin, R ;

Sessler, CN ;

Dittus, RS ;

Bernard, GR .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 289 (22) :2983-2991

← 1 2 3 4 →