Questionable Role of Antipsychotics in ICU Delirium

Antipsychotics used to treat delirium may be ineffective in treating critically ill patients admitted to the ICU, according to a new study published in the New England Journal of Medicine.

Every year, more than 7 million hospitalized patients in the United States experience delirium, making them disoriented, withdrawn, drowsy or difficult to wake.

‘Excessive use of medicines, especially antipsychotics may not provide adequate benefit to delirium patients admitted to the ICU.’

A large, multi-site MIND USA (Modifying the Incidence of Delirium) study sought to answer whether typical and atypical anti psychotics like 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, and professor of Medicine at Vanderbilt University School of Medicine.

Researchers screened nearly 21,000 patients at 16 U.S. medical centers. Of the 1,183 patients on mechanical ventilation or in shock, 566 became delirious and were randomized into groups receiving either intravenous Haloperidol, Ziprasidone or placebo (saline).
No significant difference in duration of delirium or coma among participants on Haloperidol, Ziprasidone compared to placebo was found. No significant differences among participants on either anti psychotic medication compared to placebo in 30-day and 90-day mortality or time on the ventilator, or in the ICU and hospital were found.

"Every day, there are thousands of patients receiving unnecessary anti psychotics in the critical care setting that are bringing risk and cost without benefit in the outcomes measured as per NIA-sponsored MIND-USA study," Ely said. Ely's companion ICU Liberation Collaborative investigation, released today by the Society of Critical Care Medicine, details how to streamline the best way to care for critically ill patients in the ICU by using the ABCDEF Bundle.

The study followed 15,000 patients at 70 medical centers across the United States and found that higher performance of the ABCDEF bundle saved lives, reduced length of stay, reduced delirium and coma, hospital re admissions and made patients less likely to be transferred to nursing homes, Ely said.

"In the ICU Liberation Collaborative investigation, we used a safety bundle much like what your aeroplane pilots use to help you get safely to your destination," Ely said.
"We try and provide the least amount of sedation to keep people safe and comfortable in the ICU while also managing their delirium, involving their families, getting them mobilized and walking around. ICU teams all over the world are working together to create a new culture of critical care for patients and families."

Source: Eurekalert