Short-Term Effect of Quetiapine Used to Treat Delirium Symptoms on Opioid and Benzodiazepine Requirements in the Pediatric Cardiac Intensive Care Unit

Thielen, Jessica R.; Sawyer, Jaclyn E.; Henry, Brandon M.; Zebracki, Jessica; Cooper, David S.; Koh, Wonshill

doi:10.1007/s00246-022-02980-3

Cited by 2 publications

(3 citation statements)

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“…In comparing first recorded CAPD scores between the 2 groups, median time from ICU admission to first CAPD was 26.3 h for the overall cohort and without significant difference between the 2 groups (P = .92). Patients with DD had significantly higher initial CAPD scores (Figure 1A): DD median 17 [14][15][16][17][18][19], NT median 13 [6][7][8][9][10][11][12][13][14][15][16][17], P = .02. Patients with DD had only slightly higher CAPD scores at initiation of pharmacologic treatment for delirium (Figure 1B), with median score of 18 [17][18][19][20][21] than their NT counterparts (median 16.5 [12][13][14][15][16][17][18][19], (P = .047).…”

Section: Resultsmentioning

confidence: 99%

“…Patients with DD had significantly higher initial CAPD scores (Figure 1A): DD median 17 [14][15][16][17][18][19], NT median 13 [6][7][8][9][10][11][12][13][14][15][16][17], P = .02. Patients with DD had only slightly higher CAPD scores at initiation of pharmacologic treatment for delirium (Figure 1B), with median score of 18 [17][18][19][20][21] than their NT counterparts (median 16.5 [12][13][14][15][16][17][18][19], (P = .047). Time from first CAPD score to initiation of therapy did not differ significantly between the groups, with a median of 5.8 days [1.3-10.8 days] in the DD group and 4.3 days [2.3-11.0 days] in the NT group (P = .97).…”

Section: Resultsmentioning

confidence: 99%

“…13 However, despite increased use and assumed increased comfort with quetiapine's safety profile and efficacy, it has only been shown to decrease opioid and benzodiazepine requirements in pediatric patients with congenital heart disease. 14 It has not been shown to improve delirium screening scores when compared to untreated, matched patients. 15 As such, despite the increased use of quetiapine, as described by recent publications and consistent with our findings, randomized trials of quetiapine usage for pharmacologic delirium continue to be indicated to demonstrate efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

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Differences in Delirium Evaluation and Pharmacologic Management in Children With Developmental Delay: A Retrospective Case-Control Study

Kolmar

Paton

Krämer

et al. 2023

J Intensive Care Med

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Delirium is associated with increased mortality and cost, decreased neurocognition, and decreased quality of life in the pediatric intensive care unit (PICU) population. The Cornell Assessment for Pediatric Delirium (CAPD) is used in PICUs for delirium screening but lacks specificity in children with developmental delay (DD). Within a cohort of children receiving pharmacologic treatment for intensive care unit (ICU) delirium, we compared delirium scoring and medication management between children with and without DD. We hypothesized that CAPD scores and treatment decisions would differ between DD and neurotypical (NT) patients. In this retrospective case-control study, we queried the medical record of patients admitted to our PICU with respiratory failure from June 2018 to March 2022 who received antipsychotics typically used for ICU delirium. Antipsychotics prescribed for home use were excluded. Nonparametric statistics compared demographics, CAPD scores, medication choice, dosing (mg/kg), and medication continuation after discharge between those with and without DD based on the ICD-10 codes. Twenty-one DD admissions and 59 NT admissions were included. Groups did not significantly differ by demographics, LOS, drug, or initial dosage. DD patients had higher median CAPD scores at admission (17 vs 13; P = .02) and treatment initiation (18 vs 16.5; P = .05). Providers more frequently escalated doses in DD patients (13/21 vs 21/59; P = .04) and discharged them home on new antipsychotics (7/21 vs 5/59; P = .01). DD patients experience delirium screening and management differently than NT counterparts. Providers should be aware of baseline elevated scores in DD patients and carefully attend to indications for dosage escalation. Further work is needed to understand if prolonged duration, even after hospital discharge, benefits patients, or represents potential disparity in care.

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