title: Pharmacologic prevention and treatment of delirium in intensive care patients: A systematic review.
abstract: OBJECTIVE
  The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients.
  
  
  METHODS
  We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients.
  
  
  RESULTS
  From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001).
  
  
  CONCLUSIONS
  The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Hospital Copa D'Or, Rio de Janeiro, Brazil; Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: rodrigobserafim@gmail.com.
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: Serafim
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil. Electronic address: bozza.fernando@gmail.com.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Bozza
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: marciosoaresms@gmail.com.
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: pedro.brasil@idor.org.
authors.forename: Pedro Emanuel A A
authors.initials: PE
authors.lastname: do Brasil
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: tura@centroin.com.br.
authors.forename: Bernardo R
authors.initials: BR
authors.lastname: Tura
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA; Veteran Affairs Tennessee Valley Geriatric Research Education Clinical Center (VA-GRECC), Nashville, TN, USA. Electronic address: wes.ely@vanderbilt.edu.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: jorgesalluh@gmail.com.
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003422:Critical Care; D016638:Critical Illness; D003693:Delirium / Q000188:drug therapy / Q000517:prevention & control*; D020927:Dexmedetomidine / Q000627:therapeutic use; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018967:Risperidone / Q000627:therapeutic use; D000068836:Rivastigmine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006993:Hypnotics and Sedatives; D018696:Neuroprotective Agents; D000069348:Quetiapine Fumarate; D020927:Dexmedetomidine; D006220:Haloperidol; D018967:Risperidone; D000068836:Rivastigmine
keywords: Delirium; ICU; Prevention; Surgical