TY - JOUR
T1 - Antipsychotics for preventing delirium in hospitalized adults a systematic review
AU - Oh, Esther S.
AU - Needham, Dale M.
AU - Nikooie, Roozbeh
AU - Wilson, Lisa M.
AU - Zhang, Allen
AU - Robinson, Karen A.
AU - Neufeld, Karin J.
N1 - Funding Information:
By the AHRQ (contract 290-2015-00006I-2).
Funding Information:
Disclosures: Dr. Needham reports a contract from the AHRQ during the conduct of the study. Dr. Nikooie reports a contract from the AHRQ during the conduct of the study. Dr. Neufeld reports a contract from AHRQ during the conduct of the study and personal fees from Merck and grants from Hitachi outside the submitted work. Ms. Wilson reports contract HHSA290201500006I/HHSA29032008T from AHRQ during the conduct of the study. Mr. Zhang reports a contract from the AHRQ during the conduct of the study. Dr. Robinson reports a contract from AHRQ during the conduct of the study. Dr. Neufeld reports a contract from AHRQ during the conduct of the study and personal fees from Merck and grants from Hitachi outside the submitted work. Drs. Neufeld and Needham were panel members for the Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU and the American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults. The first author and none of the other authors have any affiliations or financial involvement that conflict with the material presented in this report. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org /authors/icmje/ConflictOfInterestForms.do?msNum=M19-1859.
Funding Information:
Disclaimer: The project was funded under contract HHSA290201500006I/HHSA29032008T from the AHRQ, U.S. Department of Health and Human Services (HHS). The authors of this manuscript are responsible for its content. Statements in the manuscript do not necessarily reflect the official views of or imply endorsement by AHRQ or HHS.
Publisher Copyright:
© 2019 American College of Physicians. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. Antipsychotics are used to prevent delirium, but their benefits and harms are unclear. Purpose: To conduct a systematic review evaluating the benefits and harms of antipsychotics for prevention of delirium in adults. Data Sources: PubMed, Embase, CENTRAL, CINAHL, and Psyc- INFO from inception through July 2019, without restrictions based on study setting, language of publication, or length of follow-up. Study Selection: Randomized, controlled trials (RCTs) that compared an antipsychotic with placebo or another antipsychotic, and prospective observational studies with a comparison group. Data Extraction: One reviewer extracted data and graded the strength of the evidence, and a second reviewer confirmed the data. Two reviewers independently assessed the risk of bias. Data Synthesis: A total of 14 RCTs were included. There were no differences in delirium incidence or duration, hospital length of stay (high strength of evidence [SOE]), and mortality between haloperidol and placebo used for delirium prevention. Little to no evidence was found to determine the effect of haloperidol on cognitive function, delirium severity (insufficient SOE), inappropriate continuation, and sedation (insufficient SOE). There is limited evidence that second-generation antipsychotics may lower delirium incidence in the postoperative setting. There is little evidence that short-term use of antipsychotics was associated with neurologic harms. In some of the trials, potentially harmful cardiac effects occurred more frequently with antipsychotic use. Limitations: There was significant heterogeneity in antipsychotic dosing, route of antipsychotic administration, assessment of outcomes, and adverse events. There were insufficient or no data available to draw conclusions for many of the outcomes. Conclusion: Current evidence does not support routine use of haloperidol or second-generation antipsychotics for prevention of delirium. There is limited evidence that second-generation antipsychotics may lower the incidence of delirium in postoperative patients, but more research is needed. Future trials should use standardized outcome measures.
AB - Background: Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. Antipsychotics are used to prevent delirium, but their benefits and harms are unclear. Purpose: To conduct a systematic review evaluating the benefits and harms of antipsychotics for prevention of delirium in adults. Data Sources: PubMed, Embase, CENTRAL, CINAHL, and Psyc- INFO from inception through July 2019, without restrictions based on study setting, language of publication, or length of follow-up. Study Selection: Randomized, controlled trials (RCTs) that compared an antipsychotic with placebo or another antipsychotic, and prospective observational studies with a comparison group. Data Extraction: One reviewer extracted data and graded the strength of the evidence, and a second reviewer confirmed the data. Two reviewers independently assessed the risk of bias. Data Synthesis: A total of 14 RCTs were included. There were no differences in delirium incidence or duration, hospital length of stay (high strength of evidence [SOE]), and mortality between haloperidol and placebo used for delirium prevention. Little to no evidence was found to determine the effect of haloperidol on cognitive function, delirium severity (insufficient SOE), inappropriate continuation, and sedation (insufficient SOE). There is limited evidence that second-generation antipsychotics may lower delirium incidence in the postoperative setting. There is little evidence that short-term use of antipsychotics was associated with neurologic harms. In some of the trials, potentially harmful cardiac effects occurred more frequently with antipsychotic use. Limitations: There was significant heterogeneity in antipsychotic dosing, route of antipsychotic administration, assessment of outcomes, and adverse events. There were insufficient or no data available to draw conclusions for many of the outcomes. Conclusion: Current evidence does not support routine use of haloperidol or second-generation antipsychotics for prevention of delirium. There is limited evidence that second-generation antipsychotics may lower the incidence of delirium in postoperative patients, but more research is needed. Future trials should use standardized outcome measures.
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U2 - 10.7326/M19-1859
DO - 10.7326/M19-1859
M3 - Review article
C2 - 31476766
AN - SCOPUS:85072884064
SN - 0003-4819
VL - 171
SP - 474
EP - 484
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 7
ER -