title: Rational Use of Second-Generation Antipsychotics for the Treatment of ICU Delirium.
abstract: Delirium, described as an acute neuropsychiatric syndrome, occurs commonly in critically ill patients and leads to many negative outcomes including increased mortality and long-term cognitive deficits. Despite the lack of clinical data supporting the use of antipsychotics for the management of intensive care unit (ICU) delirium, pharmacological interventions are often needed to control acutely agitated patients. Given that the most current guidelines do not advocate the use of haloperidol for either the prevention or treatment of ICU delirium due to a lack of evidence, second-generation antipsychotics (SGAs) have been commonly used as alternatives to haloperidol for ICU patients with delirium. Nonetheless, the evidence supporting the use of SGAs to treat ICU delirium remains limited. This review is designed to assess the available clinical evidence and highlights the different neuropharmacological and safety properties of SGAs in order to guide the rational use of SGAs for the treatment of ICU delirium.
authors.affiliation: 1 Critical Care, Western New England University College of Pharmacy, Springfield, MA, USA.
authors.forename: Yoonsun
authors.initials: Y
authors.lastname: Mo
authors.affiliation: 2 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, San Diego, CA, USA.
authors.forename: Felix K
authors.initials: FK
authors.lastname: Yam
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units; D009435:Synaptic Transmission / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D003577:Cytochrome P-450 Enzyme System
keywords: delirium; olanzapine; quetiapine; risperidone; ziprasidone