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Efficacy of Low Dose Prophylactic Quetiapine on Delirium Prevention in Critically Ill Patients: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

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A6022 - Efficacy of Low Dose Prophylactic Quetiapine on Delirium Prevention in Critically Ill Patients: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
Author Block: Y. Kim1, H. Kim2, S. Lee1, J. Park1, Y. Cho1, H. Yoon1, J. Lee1, C. Lee1, Y. Lee1; 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea, Republic of, 2Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si, Korea, Republic of.
RATIONALE: Previous studies revealed quetiapine was effective in treating delirium in critically ill patients. However, there were no recommendations for pharmacologic prevention of delirium for them. We aimed to evaluate the efficacy of low dose quetiapine for delirium prevention in critically ill patients.
METHODS: A prospective, randomized controlled study was conducted in a medical intensive care unit (ICU) of Seoul National University Bundang Hospital from July 2015 to July 2017. Within 72 hours of ICU admission, patients were randomly assigned to receive either placebo or 1 dose of oral quetiapine (12.5 or 25mg) per day starting the randomization day and continuing until the 10th ICU day or ICU discharge before 10th ICU day. The primary predefined outcome was delirium diagnosed with the Confusion Assessment Method (CAM) within study period. Secondary measures were positive rate of CAM, mortality, successful extubation, and the use of rescue medication.
RESULTS: A total of 35 patients were included. The incidence of delirium during the 10 days after ICU admission was 46.7% (7/15) in the quetiapine group and 55.0% (11/20) in the control group (p=0.442). The rate of CAM positivity was significantly higher in the control group (37.4% vs. 13.5, p=0.035). More patients in the quetiapine group weaned mechanical ventilation successfully (84.6% vs. 47.1%, p=0.040) and survived (80.0% vs. 45.0%, p=0.039)
CONCLUSION: Our study suggests that prophylactic use of low dose quetiapine would be helpful for preventing delirium in critically ill patients. Further large prospective study is needed.
----------------------------------------------------------------------------------------------------------------Keyword: ICU delirium; delirium prevention; prophylactic quetiapine
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