Pharmacological Management of Delirium in Hospitalized Adults - A Systematic Evidence Review
Campbell N et al. - The existing limited data indicates no superiority for second-generation antipsychotics over haloperidol in managing delirium. Although preliminary results suggest delirium prevention may be accomplished through various mechanisms, further studies are necessary to prove effectiveness. Methods- Three reviewers independently extracted the data for participants, interventions and outcome measures, and critically appraised each study using the JADAD scale.
- Searched Medline, PubMed, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to October 2008.
- We included randomized, controlled trials comparing pharmacologic compounds either to each other or placebo.
- This study excluded non-comparison trials, studies with patients aged < 18 years, a history of an Axis I psychiatric disorder, and patients with alcohol-related delirium.
Results- This study identified 13 studies that met our inclusion criteria and evaluated 15 compounds:
- second-generation antipsychotics,
- first-generation antipsychotics,
- cholinergic enhancers,
- an antiepileptic agent,
- an inhaled anesthetic,
- injectable sedatives,
- and a benzodiazepine.
- Four trials evaluated delirium treatment and suggested no differences in efficacy or safety among the evaluated treatment methods (first and second generation antipsychotics).
- Neither cholinesterase inhibitors nor procholinergic drugs were effective in preventing delirium.
- Multiple studies, however, suggest either shorter severity and duration, or prevention of delirium with the use of haloperidol, risperidone, gabapentin, or a mixture of sedatives in patients undergoing elective or emergent surgical procedures.
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