Original Research
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Introduction: Clonidine or antipsychotics are often used to treat ICU delirium despite their lack of proven benefit and guidelines not recommending routine use. A pharmacologic intervention that reduces delirium faster, when combined with non-pharmacologic delirium reduction strategies, may improve patient outcomes.
Research Question or Hypothesis: Is there a difference in the time to first delirium resolution in critically ill adults with incident delirium who are treated with clonidine versus an antipsychotic (haloperidol/quetiapine)?
Study Design: Prospective cohort study.
Methods: We included consecutive adults admitted to a 32-bed mixed Dutch ICU between 2011?2019 who first developed delirium (a day with =1 positive CAM-ICU) after ICU admission, and who were administered clonidine or an antipsychotic (haloperidol/quetiapine) after delirium occurrence. Patients who received both clonidine and an antipsychotic or experienced coma after delirium were excluded. The first post-treatment day without a positive CAM-ICU denoted delirium resolution. A Cox proportional hazards regression model that accounted for baseline [age, medical (vs. surgical) admission, APACHE-IV score, Charlson Comorbidity Index] and daily (SOFA, invasive mechanical ventilation, opioid use, and benzodiazepine/propofol use) variables, and daily use of clonidine (or antipsychotics), was constructed.
Results: At baseline, the clonidine (n=77) [vs. antipsychotic (n=149)] group was younger [median (IQR) 61(51?70) vs. 66(58?76), p<0.01] and more likely medical (52% vs. 34%, p=0.02); severity of illness (APACHE-IV) was similar. Total treatment duration until delirium resolution or ICU discharge was similar [clonidine 2(1?2) vs. antipsychotic 2(1?3) days, p=0.42]. While delirium resolved in a similar proportion of patients (clonidine 70% vs. antipsychotic 61%, p=0.23), clonidine (vs antipsychotic) use was associated with a greater daily probability of ICU delirium resolution (adjusted hazard ratio=1.83, 95% CI 1.23?2.70).
Conclusion: After adjusting for both baseline and time-varying covariates, treatment with clonidine, rather than haloperidol or quetiapine, was associated with an 83% increased daily rate of ICU delirium resolution. Additional research is needed to confirm these findings.
Presenting Author
Ting-Ting Wu PharmDTaipei Municipal Wan Fang Hospital
Authors
John Devlin PharmD, FCCP
Northeastern University
Arjen Slooter MD, PhD
University Medical Center (UMC) Utrecht Brain Center
Louisa Smith PhD
Northeastern university
Gillian Steiger PharmD candidate
Northeastern University