title: Quetiapine in refractory hyperactive and mixed intensive care delirium: a case series.
abstract: BACKGROUND
  Delirium affects up to 80% of patients admitted to intensive care units (ICUs) and contributes to increased morbidity and mortality. Haloperidol is the gold standard for treatment, although quetiapine has been successfully used in the management of delirium.
  
  
  METHODS
  We conducted a retrospective study of patients admitted to the ICU between February 2008 and May 2010 who were prescribed quetiapine by the attending clinician. Data collected included demographics, history of drug and/or alcohol dependence, ICU and hospital length of stay, length of mechanical ventilation and the duration of treatment with sedatives and medications for delirium. The daily dose of quetiapine was recorded. Hyperactive or mixed delirium was identified by a validated chart review and a Richmond Agitation Sedation Scale (RASS) score persistently greater than 1 for 48 hours despite therapy.
  
  
  RESULTS
  Seventeen patients were included. Delirium onset occurred after a median of five days. Patients were being given at least four agents for delirium prior to the introduction of quetiapine, and they had a median RASS score of 3. Quetiapine was initiated at a 25 mg daily dose and titrated to a median daily dose of 50 mg. The median duration of delirium prior to quetiapine therapy was 15 days. Quetiapine commencement was associated with a reduction in the need for other medications (within 0 to 6 days) and resolution of delirium within a median of four days. Adverse events included somnolence and transient hypotension.
  
  
  CONCLUSIONS
  This case series provides an initial effort to explore a possible role for quetiapine in the management of refractory hyperactive and mixed ICU delirium.
authors.affiliation: Institute of Pharmaceutical Sciences, Kings College London and Department of Pharmacy Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Ruth Y Y
authors.initials: RY
authors.lastname: Wan
authors.forename: Moneesha
authors.initials: M
authors.lastname: Kasliwal
authors.forename: Catherine A
authors.initials: CA
authors.lastname: McKenzie
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Barrett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000188:drug therapy* / Q000453:epidemiology; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000453:epidemiology; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies
chemical_list: D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate