(1028) Evaluation of Antipsychotics in Treatment of Hyperactive Delirium in Surgical ICU

Introduction: To determine the effectiveness of haloperidol, quetiapine, risperidone, and olanzapine in the treatment of hyperactive ICU delirium

Methods: This study is a multicenter, retrospective review of adult medical records who experienced hyperactive delirium in surgical ICU between January 2020 and February 2024. All patients in the review received non-pharmacological interventions as first line treatment for management of delirium. The review focused on patients who received haloperidol, quetiapine, risperidone, and olanzapine for hyperactive delirium. The study examined duration of delirium, in hospital mortality, time on mechanical ventilation, percentage of delirium free days in a surgical ICU, and side effects of the antipsychotics.

Results: There are total of 201 patients enrolled in the study, 23 in haloperidol group; 50 in olanzapine group; 122 in quetiapine group; and 6 in risperidone group. Percentage of delirium-free days in the surgical ICU were similar across 4 groups, with percentages of 80% for haloperidol, 81% for olanzapine, 73% for quetiapine, and 80% for risperidone (p = 0.3). The quetiapine group had more delirium- and coma- free days during surgical ICU stay (13 [IQR 6,25], p = 0.014 and 18 [IQR 9,32], p = 0.001). The quetiapine group had higher surgical ICU admission APACHE II scores (17 [IQR 12,21], p = 0.7) compared to other antipsychotics, potentially leading to increased mechanical ventilation (89 [86%], p = 0.001), prolonged extubation time (7 days [IQR 3,16], p = 0.025), and the longest hospital and surgical ICU stays (33 days [IQR 19,55], p = 0.018 and 18 days [IQR 9,36], p = < 0.001). QTc had median values of 463 [IQR 44,484] for haloperidol, 460 [IQR 446,491] for olanzapine, 469 [IQR 445,499] for quetiapine, and 472 [IQR 470,484] for risperidone (p = 0.8). There was no difference in incidence of extrapyramidal symptoms in all groups.

Conclusions: Our study demonstrated that antipsychotic use in hyperactive delirium is associated with high percentage of delirium-free days in surgical ICU. Further studies are needed to validate the most efficacious antipsychotic in treating ICU delirium.