title: Antipsychotic prescribing patterns, and the factors and outcomes associated with their use, among patients requiring prolonged mechanical ventilation in the long-term acute care hospital setting.
abstract: BACKGROUND
  Administration of scheduled antipsychotic therapy to mechanically ventilated patients to prevent or treat delirium is common, despite the lack of evidence to support its use. Among long-term acute care hospital (LTACH) patients requiring prolonged mechanical ventilation (PMV), the frequency of scheduled antipsychotic therapy use, and the factors and outcomes associated with it, have not been described.
  
  
  OBJECTIVE
  To identify scheduled antipsychotic therapy prescribing practices, and the factors and outcomes associated with the use of antipsychotics, among LTACH patients requiring PMV.
  
  
  METHODS
  Consecutive patients without major psychiatric disorders or dementia who were admitted to an LTACH for PMV over 1 year were categorized as those receiving scheduled antipsychotic therapy (≥24 hours of use) and those not receiving scheduled antipsychotic therapy. Presence of delirium, use of psychiatric evaluation, nonscheduled antipsychotic therapy, and scheduled antipsychotic therapy-related adverse effects were extracted and compared between the 2 groups and when significant (p ≤ 0.05), were entered into a regression analysis using generalized estimating equation techniques.
  
  
  RESULTS
  Among 80 patients included, 39% (31) received scheduled antipsychotic therapy and 61% (49) did not. Baseline characteristics, including age, sex, illness severity, and medical history, were similar between the 2 groups. Scheduled antipsychotic therapy was administered on 52% of LTACH days for a median (interquartile range [IQR]) of 25 (6-38) days and, in the antipsychotic group, was initiated at an outside hospital (45%) or on day 2 (1-6; median [IQR]) of the LTACH stay (55%). Quetiapine was the most frequently administered scheduled antipsychotic (77%; median dose 50 [37-72] mg/day). Use of scheduled antipsychotic therapy was associated with a greater incidence of psychiatric evaluation (OR 5.7; p = 0.01), delirium (OR 2.4; p = 0.05), as-needed antipsychotic use (OR 4.1; p = 0.005) and 1:1 sitter use (OR 7.3; p = 0.001), but not benzodiazepine use (p = 0.19).
  
  
  CONCLUSIONS
  Among LTACH patients requiring PMV, scheduled antipsychotic therapy is used frequently and is associated with a greater incidence of psychiatric evaluation, delirium, as-needed psychotic use, and sitter use. Although scheduled antipsychotic therapy-related adverse effects are uncommon, these effects are infrequently monitored.
authors: School of Pharmacy, Northeastern University, Boston, MA, USA.
authors: Nada S
authors: NS
authors: Al-Qadheeb
authors: Heidi H
authors: HH
authors: O'Connor
authors: Alexander C
authors: AC
authors: White
authors: Aura
authors: A
authors: Neidhardt
authors: Mark
authors: M
authors: Albizati
authors: Bernard
authors: B
authors: Joseph
authors: Russel J
authors: RJ
authors: Roberts
authors: Robin R
authors: RR
authors: Ruthazer
authors: John W
authors: JW
authors: Devlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017028:Caregivers; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006763:Hospitals, Chronic Disease; D006801:Humans; D008297:Male; D008404:Massachusetts; D008499:Medical Records; D008875:Middle Aged; D010358:Patient Participation; D010818:Practice Patterns, Physicians'; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate; D012121:Respiration, Artificial / Q000523:psychology*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate