quetiapine-fumarate and Postoperative-Complications

Topics: Antipsychotic Agents; Cardiac Surgical Procedures; Female; Humans; Methylene Blue; Middle Aged; Paroxetine; Postoperative Complications; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome

The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients.. We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients.. From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001).. The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.

Topics: Antipsychotic Agents; Critical Care; Critical Illness; Delirium; Dexmedetomidine; Haloperidol; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypnotics and Sedatives; Intensive Care Units; Length of Stay; Neuroprotective Agents; Postoperative Complications; Quetiapine Fumarate; Respiration, Artificial; Risperidone; Rivastigmine; Treatment Outcome

Delirium occurs frequently in critically ill children, and children with neuroblastoma may be at particular risk. Early diagnosis and treatment may improve short- and long-term outcomes. In this case series, we present four critically ill children with neuroblastoma who were diagnosed with delirium in the post-operative period. In all four patients, the diagnosis of delirium facilitated targeted intervention and improvement. Heightened awareness by pediatric oncologists, surgeons, and intensivists may lead to earlier diagnosis and improvement in clinical outcomes.

Topics: Benzodiazepines; Child, Preschool; Cholinergic Antagonists; Delirium; Dibenzothiazepines; Female; Humans; Infant; Male; Narcotics; Neuroblastoma; Pain, Postoperative; Postoperative Complications; Quetiapine Fumarate; Risk Factors; Soft Tissue Neoplasms; Sotos Syndrome