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Quetiapine once daily versus twice daily for treatment of icu delirium
JACCP Journal of the American College of Clinical Pharmacy ; 5(12):1368, 2022.
Article in English | EMBASE | ID: covidwho-2173033
ABSTRACT

Introduction:

Although guidelines recommend twice daily (BID) dosing of quetiapine for treatment of intensive care unit (ICU) delirium in most patients, once daily dosing at bedtime (HS) is commonly prescribed to reduce daytime somnolence. No studies have evaluated differences in outcomes. Research Question or

Hypothesis:

To determine if BID dosing of quetiapine reduces duration of delirium versus HS dosing for treatment of ICU delirium. Study

Design:

Retrospective analysis of ICU patients treated with BID versus HS dosing of quetiapine for ICU delirium. Method(s) Electronic health records were analyzed between January 1, 2017 and December 31, 2021 for patients prescribed quetiapine for ICU delirium. Patients were excluded for alcohol withdrawal, history of psychiatric conditions, receipt of <24 hours of therapy, alternative dosing variations, and death or transfer from the ICU <24 hours after beginning quetiapine. The primary outcome was recovery of delirium per Confusion Assessment Method (CAM-ICU) evaluated with Mann- Whitney U. Secondary outcomes included lengths of stay, mechanical ventilation duration, in-hospital death, and QTc prolongation. Unpaired t-test, chi-square with yates' correction, and Fisher's exact test were performed as appropriate using Graph-Pad Prism. Result(s) Baseline characteristics differed for sex in BID (38.9% female, n=23) versus HS (61.1% female, n=18) dosing and admission diagnosis (38.9% vs 17.4% COVID-19, respectively). No differences in time to delirium recovery [3 days (interquartile range [IQR], 2-5) vs 2.5 days (IQR, 1-5;p=0.6651)], ICU length of stay [16.9 days (standard deviation [SD], 9) versus 18.5 days (SD=13);p=0.6651)], duration of mechanical ventilation [9.6 (SD=8) vs 13.9 days (SD=12);p=0.2587)], or in-hospital death (60.9% vs 50%;p=0.7047) existed in the BID versus HS dosing group, respectively. Incidence of QTc prolongation was also similar between groups. Conclusion(s) Twice daily versus bedtime dosing of quetiapine did not significantly alter outcomes. These findings suggest similar efficacy without increased adverse events.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: JACCP Journal of the American College of Clinical Pharmacy Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: JACCP Journal of the American College of Clinical Pharmacy Year: 2022 Document Type: Article