The pharmacologic treatment of intensive care unit delirium: a systematic review

Ann Pharmacother. 2013 Sep;47(9):1168-74. doi: 10.1177/1060028013500466.

Abstract

Objective: To systematically evaluate the treatment of ICU delirium.

Data sources: Literature searches were conducted using PubMed and Ovid MEDLINE (January 1980 to March 2013). Clinical trials/reports evaluating the use of pharmacologic treatment for ICU delirium were selected. References from major guidelines and publications were reviewed.

Study selection and data extraction: English-language articles related to the treatment of ICU delirium were included. The following were excluded: (1) used pharmacologic treatment for the prevention of delirium; (2) inclusion of non-critically ill, palliative care, or hospice care patients; (3) letters to the editor; (4) case studies; (5) case series; (6) studies without delirium-related end points; and (7) studies with a predominantly postoperative population. Data extracted included: study design, population, treatment, number of participants, end points, outcomes/authors' conclusions, and adverse effects.

Data synthesis: Four studies were included in this review. The US Preventative Services Task Force classification scheme was used to assess the quality of evidence. All 4 studies reviewed were level I evidence studies. There are few well-designed, randomized studies that evaluate ICU delirium treatment. The 2 main randomized studies have small sample sizes and methodological concerns. Antipsychotic therapy may reduce the duration of ICU delirium. However, more robust studies are needed to demonstrate benefit.

Conclusions: There is a lack of evidence supporting pharmacologic treatment for ICU delirium. Prospective, well-designed studies using proper delirium identification tools and severity are necessary to confirm the overall impact of pharmacologic therapy on the duration of delirium and associated complications.

Keywords: ICU delirium; antipsychotics; delirium assessment; treatment.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antipsychotic Agents / therapeutic use
  • Delirium / drug therapy*
  • Humans
  • Intensive Care Units*

Substances

  • Antipsychotic Agents