Impact of Early Reinitiation of Neuropsychiatric Medications on Agitation and Delirium in the Intensive Care Unit: A Retrospective Study

被引:4
作者
Cucci, Michaelia D. [1 ]
Cunningham, Brittany S. [1 ]
Patel, Jaimini S. [1 ]
Shimer, Alan T. [1 ]
Mofleh, Dania I. [1 ]
Mullen, Chanda L. [1 ]
机构
[1] Cleveland Clin Akron Gen, Akron, OH USA
关键词
neuropsychiatric; agitation; delirium; withdrawal; restraints; antipsychotics; SEROTONIN REUPTAKE INHIBITORS; DISCONTINUATION SYNDROME; RISK-FACTORS; ADMISSION; ICU; RECONCILIATION; PREVENTION;
D O I
10.1177/1060028020935589
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background:Approximately 17% of intensive care unit (ICU) patients are prescribed at least 1 home neuropsychiatric medication (NPM). When abruptly discontinued, withdrawal symptoms may occur manifesting as agitation or delirium in the ICU setting.Objective:To evaluate the impact of early reinitiation of NPMs.Methods:This was a retrospective, observational cohort of adult ICU patients in a tertiary care hospital. Patients were included if admitted to the ICU and prescribed a NPM prior to arrival. Study groups were based on the timing of reinitiation of at least 50% of NPMs: <= 72 hours (early group) versus >72 hours (late group).Results:The primary outcome was the proportion of patients with at least 1 agitation or delirium episode in the first 72 hours. Agitation and delirium were defined as at least 1 RASS assessment between +2 to +4 and a positive CAM-ICU assessment, respectively. A total of 300 patients were included, with 187 (62%) and 113 (38%) in the early and late groups, respectively. There was no difference in agitation or delirium (late 54 [48%] vs early 62 [33%]; adjusted odds ratio [aOR] = 1.5; 95% CI = 0.8-2.8;P= 0.193). Independent risk factors found to be associated with the primary outcome were restraints (aOR = 12.9; 95% CI = 6.9-24.0;P< 0.001) and benzodiazepines (BZDs; aOR = 2.0; 95% CI = 1.0-3.7;P= 0.038).Conclusions:After adjustment for baseline differences, there was no difference in agitation or delirium. Independent risk factors were restraint use and newly initiated BZDs.
引用
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页码:15 / 24
页数:10
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