title: The pharmacologic treatment of intensive care unit delirium: a systematic review.
abstract: OBJECTIVE
  To systematically evaluate the treatment of ICU delirium.
  
  
  METHODS
  Literature searches were conducted using PubMed and Ovid MEDLINE (January 1980 to March 2013). Clinical trials/reports evaluating the use of pharmacologic treatment for ICU delirium were selected. References from major guidelines and publications were reviewed.
  
  
  METHODS
  English-language articles related to the treatment of ICU delirium were included. The following were excluded: (1) used pharmacologic treatment for the prevention of delirium; (2) inclusion of non-critically ill, palliative care, or hospice care patients; (3) letters to the editor; (4) case studies; (5) case series; (6) studies without delirium-related end points; and (7) studies with a predominantly postoperative population. Data extracted included: study design, population, treatment, number of participants, end points, outcomes/authors' conclusions, and adverse effects.
  
  
  RESULTS
  Four studies were included in this review. The US Preventative Services Task Force classification scheme was used to assess the quality of evidence. All 4 studies reviewed were level I evidence studies. There are few well-designed, randomized studies that evaluate ICU delirium treatment. The 2 main randomized studies have small sample sizes and methodological concerns. Antipsychotic therapy may reduce the duration of ICU delirium. However, more robust studies are needed to demonstrate benefit.
  
  
  CONCLUSIONS
  There is a lack of evidence supporting pharmacologic treatment for ICU delirium. Prospective, well-designed studies using proper delirium identification tools and severity are necessary to confirm the overall impact of pharmacologic therapy on the duration of delirium and associated complications.
authors.affiliation: University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Bathula
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Gonzales
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units
chemical_list: D014150:Antipsychotic Agents
keywords: ICU delirium; antipsychotics; delirium assessment; treatment