Antipsychotic prescribing patterns, and the factors and outcomes associated with their use, among patients requiring prolonged mechanical ventilation in the long-term acute care hospital setting

• Published in: The Annals of pharmacotherapy Vol. 47; no. 2; p. 181
• Main Authors: Al-Qadheeb, Nada S, O'Connor, Heidi H, White, Alexander C, Neidhardt, Aura, Albizati, Mark, Joseph, Bernard, Roberts, Russel J, Ruthazer, Robin R, Devlin, John W
• Format: Journal Article
• Language: English
• Published: United States 01.02.2013
• Subjects: Adult; Aged; Aged, 80 and over; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Benzodiazepines - administration & dosage; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Caregivers; Cohort Studies; Delirium - diagnosis; Delirium - drug therapy; Delirium - physiopathology; Delirium - prevention & control; Dibenzothiazepines - administration & dosage; Dibenzothiazepines - adverse effects; Dibenzothiazepines - therapeutic use; Drug Administration Schedule; Female; Hospitals, Chronic Disease; Humans; Male; Massachusetts; Medical Records; Middle Aged; Patient Participation; Practice Patterns, Physicians; Psychiatric Status Rating Scales; Quetiapine Fumarate; Respiration, Artificial - psychology; Retrospective Studies; Massachusetts
• ISSN: 1542-6270
• DOI: 10.1345/aph.1R521

Administration of scheduled antipsychotic therapy to mechanically ventilated patients to prevent or treat delirium is common, despite the lack of evidence to support its use. Among long-term acute care hospital (LTACH) patients requiring prolonged mechanical ventilation (PMV), the frequency of scheduled antipsychotic therapy use, and the factors and outcomes associated with it, have not been described. To identify scheduled antipsychotic therapy prescribing practices, and the factors and outcomes associated with the use of antipsychotics, among LTACH patients requiring PMV. Consecutive patients without major psychiatric disorders or dementia who were admitted to an LTACH for PMV over 1 year were categorized as those receiving scheduled antipsychotic therapy (≥24 hours of use) and those not receiving scheduled antipsychotic therapy. Presence of delirium, use of psychiatric evaluation, nonscheduled antipsychotic therapy, and scheduled antipsychotic therapy-related adverse effects were extracted and compared between the 2 groups and when significant (p ≤ 0.05), were entered into a regression analysis using generalized estimating equation techniques. Among 80 patients included, 39% (31) received scheduled antipsychotic therapy and 61% (49) did not. Baseline characteristics, including age, sex, illness severity, and medical history, were similar between the 2 groups. Scheduled antipsychotic therapy was administered on 52% of LTACH days for a median (interquartile range [IQR]) of 25 (6-38) days and, in the antipsychotic group, was initiated at an outside hospital (45%) or on day 2 (1-6; median [IQR]) of the LTACH stay (55%). Quetiapine was the most frequently administered scheduled antipsychotic (77%; median dose 50 [37-72] mg/day). Use of scheduled antipsychotic therapy was associated with a greater incidence of psychiatric evaluation (OR 5.7; p = 0.01), delirium (OR 2.4; p = 0.05), as-needed antipsychotic use (OR 4.1; p = 0.005) and 1:1 sitter use (OR 7.3; p = 0.001), but not benzodiazepine use (p = 0.19). Among LTACH patients requiring PMV, scheduled antipsychotic therapy is used frequently and is associated with a greater incidence of psychiatric evaluation, delirium, as-needed psychotic use, and sitter use. Although scheduled antipsychotic therapy-related adverse effects are uncommon, these effects are infrequently monitored.