title: Implications of atypical antipsychotic prescribing in the intensive care unit.
abstract: OBJECTIVE
  The purpose of the study was to determine the downstream implications of atypical antipsychotic (AAP) prescribing in the intensive care unit (ICU), including discharge prescribing practices, monitoring, and attributable adverse drug events.
  
  
  METHODS
  This retrospective cohort study included patients at least 18 years of age admitted to an ICU that received at least 2 doses of an AAP for documented delirium or avoidance of a deliriogenic medication. Exclusion criteria were documentation of an AAP as a home medication or initiation for a psychiatric indication unrelated to delirium (eg, schizophrenia).
  
  
  RESULTS
  During the 8-month study period, 156 patients were included and 133 (85.2%) patients survived to hospital discharge. Of the survivors, AAP therapy was continued for 112 (84.2%) patients upon ICU transfer and for 38 (28.6%) patients upon hospital discharge. A majority of these patients had evidence of delirium resolution or no indication for continuation documented at discharge. Of the 127 patients with an electrocardiogram ordered during AAP therapy, QTc prolongation occurred in 49 (31.4%) patients. An adverse drug event leading to drug discontinuation was documented in 16 (10.2%) patients.
  
  
  CONCLUSIONS
  Because of significant patient-centered implications, AAPs initiated in the ICU require continued evaluation for indication to avoid prolonged and possibly unnecessary use.
authors.affiliation: Duke University Hospital, DUMC Box 3089, Durham, NC, United States 27710. Electronic address: Bridgette.Kram@duke.edu.
authors.forename: Bridgette L
authors.initials: BL
authors.lastname: Kram
authors.affiliation: Duke University Hospital, DUMC Box 3089, Durham, NC, United States 27710. Electronic address: Shawn.Kram@duke.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Kram
authors.affiliation: Duke University Hospital, DUMC Box 3089, Durham, NC, United States 27710. Electronic address: Kelli.Brooks@dm.duke.edu.
authors.forename: Kelli R
authors.initials: KR
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000009:adverse effects / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003693:Delirium / Q000188:drug therapy*; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010351:Patient Discharge; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D000069348:Quetiapine Fumarate / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D017741:Survivors; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine
keywords: Antipsychotic agents; Care transitions; Delirium