Quetiapine for delirium prophylaxis in high-risk critically ill patients

Surgeon. 2021 Apr;19(2):65-71. doi: 10.1016/j.surge.2020.02.002. Epub 2020 Mar 23.


Background: Delirium is common in patients admitted to the surgical trauma intensive care unit (ICU), and the risk factors for these patients differ from medical patients. Given the morbidity and mortality associated with delirium, efforts to prevent it may improve patient outcomes, but previous efforts pharmacologically have been limited by side effects and insignificant results. We hypothesized that scheduled quetiapine could reduce the incidence of delirium in this population.

Methods: The study included 71 adult patients who were at high-risk for the development of delirium (PRE-DELIRIC Score ≥50%, history of dementia, alcohol misuse, or drug abuse). Patients were randomized to receive quetiapine 12.5 mg every 12 h for delirium or no pharmacologic prophylaxis within 48 h of admission to the ICU. The primary end point was the incidence of delirium during admission to the ICU. Secondary end points included time to onset of delirium, ICU and hospital length of stay (LOS), ICU and hospital mortality, duration of mechanical ventilation, and adverse events.

Results: The incidence of delirium during admission to the ICU was 45.5% (10/22) in the quetiapine group and 77.6% (38/49) in the group that did not receive pharmacological prophylaxis. The mean time to onset of delirium was 1.4 days for those who did not receive prophylaxis versus 2.5 days for those who did (p = 0.06). The quetiapine group significantly reduced ventilator duration from 8.2 days to 1.5 days (p = 0.002).

Conclusions: The findings suggested that scheduled, low-dose quetiapine is effective in preventing delirium in high-risk, surgical trauma ICU patients.

Keywords: Delirium; Intensive care unit; Quetiapine; Surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Antipsychotic Agents / therapeutic use*
  • Chemoprevention
  • Critical Illness
  • Delirium / prevention & control*
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Prospective Studies
  • Quetiapine Fumarate / therapeutic use*
  • Risk Assessment
  • Risk Factors
  • Trauma Severity Indices
  • Wounds and Injuries / therapy*


  • Antipsychotic Agents
  • Quetiapine Fumarate