Pharmacological management of delirium in hospitalized adults--a systematic evidence review.
OBJECTIVE
Despite the significant burden of delirium among hospitalized adults, there is no approved pharmacologic intervention for delirium. This systematic review evaluates the efficacy and safety of pharmacologic interventions targeting either prevention or management of delirium.


METHODS
We searched Medline, PubMed, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to October 2008. We included randomized, controlled trials comparing pharmacologic compounds either to each other or placebo. We excluded non-comparison trials, studies with patients aged < 18 years, a history of an Axis I psychiatric disorder, and patients with alcohol-related delirium.


METHODS
Three reviewers independently extracted the data for participants, interventions and outcome measures, and critically appraised each study using the JADAD scale.


RESULTS
We identified 13 studies that met our inclusion criteria and evaluated 15 compounds: second-generation antipsychotics, first-generation antipsychotics, cholinergic enhancers, an antiepileptic agent, an inhaled anesthetic, injectable sedatives, and a benzodiazepine. Four trials evaluated delirium treatment and suggested no differences in efficacy or safety among the evaluated treatment methods (first and second generation antipsychotics). Neither cholinesterase inhibitors nor procholinergic drugs were effective in preventing delirium. Multiple studies, however, suggest either shorter severity and duration, or prevention of delirium with the use of haloperidol, risperidone, gabapentin, or a mixture of sedatives in patients undergoing elective or emergent surgical procedures.


CONCLUSIONS
The existing limited data indicates no superiority for second-generation antipsychotics over haloperidol in managing delirium. Although preliminary results suggest delirium prevention may be accomplished through various mechanisms, further studies are necessary to prove effectiveness.
Department of Pharmacy, Wishard Health Services, Indianapolis, IN, USA.
Noll
N
Campbell
Malaz A
MA
Boustani
Amir
A
Ayub
George C
GC
Fox
Stephanie L
SL
Munger
Carol
C
Ott
Oscar
O
Guzman
Mark
M
Farber
Adetayo
A
Ademuyiwa
Ranjeet
R
Singh
D000328:Adult; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy*; D006220:Haloperidol / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use
D018685:Anesthetics, Inhalation; D000927:Anticonvulsants; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D006220:Haloperidol