Antipsychotic drugs do not work in ICU delirium, study finds

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Antipsychotic medications are ineffective for treatment of delirium in critically ill patients in ICU

Critically ill patients do not benefit from antipsychotic medications that have been used to treat delirium in intensive care units (ICUs), according to a study released in the New England Journal of Medicine.

Delirium is a sudden state of severe confusion and rapid changes in brain function, sometimes associated with hallucinations and hyperactivity.

During a delirium a patient is unable to think or speak in a normal way.

Delirium affects millions of hospitalized patients all over the world, making them disoriented, withdrawn, drowsy or difficult to wake.

THE RESEARCHERS FOUND NO SIGNIFICANT DIFFERENCE IN DURATION OF DELIRIUM OR COMA AMONG PARTICIPANTS ON HALOPERIDOL OR ZIPRASIDONE COMPARED TO PLACEBO

This study called, Modifying the INcidence of Delirium (MIND USA) sought to establish whether typical and atypical antipsychotics (haloperidol or ziprasidone) affected delirium, survival, length of stay or safety.

“We found, after extensive investigation with medical centers all over the country, that the patients who get these potentially dangerous drugs are not experiencing any improvements whatsoever in delirium, coma, length of stay or survival,” said senior author E. Wesley Ely, MD, MPH, professor of Medicine at Vanderbilt University School of Medicine.

About 21,000 patients were screened at 16 U.S. medical centers for this study. Of the 1,183 patients on mechanical ventilation or in shock, 566 became delirious and were randomly assigned into groups receiving either intravenous haloperidol, ziprasidone or placebo (saline).

The researchers found no significant difference in duration of delirium or coma among participants on haloperidol or ziprasidone compared to placebo.

Similarly, no significant differences was observed among participants on either antipsychotic medication compared to placebo in 30-day and 90-day mortality or time on the ventilator, or in the ICU and hospital.

“Every day, there are many thousands of patients receiving unnecessary antipsychotics in the critical care setting that are bringing risk and cost without benefit with respect to the outcomes measured in this NIA-sponsored MIND-USA study,” Ely concluded.

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