The following is a summary of “Antipsychotics in the Treatment of Delirium in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” published in the July 2024 issue of Critical Care by Carayannopoulos et al.
Researchers conducted a retrospective study evaluating the effects of antipsychotic medications on patient outcomes in adults with critical illness experiencing delirium.
They searched major databases like Ovid MEDLINE, EMBASE, PsycInfo, and clinical trial registries .gov and WHO (November 2023). The titles were screened independently, and abstracts were duplicated to assess eligibility. Studies meeting criteria underwent full-text review focusing on parallel-group RCTs involving adults with critical illness experiencing delirium. The key difference was the intervention group receiving antipsychotic medications (any dosage) compared to the control group receiving usual care or a placebo. Data extraction was done independently and in duplicate using a pre-tested form, while RevMan software was employed for statistical analysis.
The result showed 5 relevant studies with over 1,750 participants, and no significant benefit was observed from using antipsychotic medications than placebo for adults critically ill with delirium. This means neither group showed a clear difference in the number of days patients were free from delirium or coma (MD 0.90 d; 95% CI, –0.32 to 2.12; moderate certainty), mortality rates, duration of ventilation, or hospital stay. Additionally, the use of antipsychotics did not lead to a higher risk of side effects or AEs (risk ratio (RR) 1.27; 95% CI, 0.71–2.30; high certainty). Analysis of subgroups comparing typical and atypical antipsychotics did not reveal any specific effects on outcomes.
Investigators concluded that despite moderate certainty, antipsychotic treatment does not show a difference in delirium or coma-free days among adults with critical illness, indicating a need for targeted research in hyperactive cases of delirium.
