Short-Term Effect of Quetiapine Used to Treat Delirium Symptoms on Opioid and Benzodiazepine Requirements in the Pediatric Cardiac Intensive Care Unit

Pediatr Cardiol. 2024 Mar;45(3):666-672. doi: 10.1007/s00246-022-02980-3. Epub 2022 Aug 7.

Abstract

Opioids or benzodiazepines use is known to increase the risk of delirium. The prevalence of delirium is high in pediatric cardiac intensive care units (CICUs) with associated morbidity and mortality. We investigate the short-term effects of quetiapine, an atypical antipsychotic medication, on opioid and benzodiazepine requirements, and any associated adverse events as we utilize quetiapine to treat delirium symptoms in this single-center, retrospective study. Twenty-eight patients who received quetiapine between January 2018 and June 2019 in the CICU met inclusion criteria for the analysis. The quetiapine initiation dose was 0.5 mg/kg/dose every 8 h and we allowed 48 h for quetiapine to reach a steady state. Overall opioid and benzodiazepine requirements were compared 72 h before and 72 h after the quetiapine steady state. There was a statistically significant reduction in the total daily opioid (p = 0.001) and benzodiazepine (p = 0.01) amounts following quetiapine initiation. There was also a statistically significant decrease in the total number of daily PRNs requirement for both opioids (p < 0.001) and benzodiazepines (p = 0.03). Nine out of 13 patients were completely weaned off continuous opioid drips following quetiapine initiation (p = 0.01). The presence of steady-state habituation medications, including methadone or lorazepam, did not have any statistically significant effect on weaning continuous opioid (p = 0.18) or benzodiazepine (p = 0.62) drips. There was no statistically significant effect of quetiapine on the QTc interval after quetiapine initiation (p = 0.58) with no clinically significant arrhythmias observed during the study period. Our study demonstrates a statistically significant reduction in opioid and benzodiazepine requirements following quetiapine initiation to treat delirium symptoms without significant adverse effects in patients with congenital heart disease in the short term.

Keywords: Agitation; Benzodiazepine; Cardiac intensive care; Congenital heart disease; Delirium; Opioid; Quetiapine.

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Antipsychotic Agents* / adverse effects
  • Benzodiazepines / therapeutic use
  • Child
  • Delirium* / drug therapy
  • Delirium* / epidemiology
  • Humans
  • Intensive Care Units, Pediatric
  • Quetiapine Fumarate / adverse effects
  • Retrospective Studies

Substances

  • Quetiapine Fumarate
  • Benzodiazepines
  • Analgesics, Opioid
  • Antipsychotic Agents