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

Autor:	Cucci MD; Cleveland Clinic Akron General, Akron, OH, USA., Cunningham BS; Cleveland Clinic Akron General, Akron, OH, USA., Patel JS; Cleveland Clinic Akron General, Akron, OH, USA., Shimer AT; Cleveland Clinic Akron General, Akron, OH, USA., Mofleh DI; Cleveland Clinic Akron General, Akron, OH, USA., Mullen CL; Cleveland Clinic Akron General, Akron, OH, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2021 Jan; Vol. 55 (1), pp. 15-24. Date of Electronic Publication: 2020 Jun 21.
DOI:	10.1177/1060028020935589
Abstrakt:	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.
Databáze:	MEDLINE
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