Antipsychotics in the Treatment of Delirium in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kallirroi Laiya Carayannopoulos; Fayez Alshamsi; Dipayan Chaudhuri; Laura Spatafora; Joshua Piticaru; Kaitryn Campbell; Waleed Alhazzani; Kimberley Lewis

doi:10.1097/CCM.0000000000006251

Antipsychotics in the Treatment of Delirium in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Crit Care Med. 2024 Mar 21. doi: 10.1097/CCM.0000000000006251. Online ahead of print.

Authors

Kallirroi Laiya Carayannopoulos^{1

2}, Fayez Alshamsi³, Dipayan Chaudhuri^{1

2}, Laura Spatafora¹, Joshua Piticaru⁴, Kaitryn Campbell⁵, Waleed Alhazzani^{1

2}, Kimberley Lewis^{1

2}

Affiliations

¹ Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
³ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
⁴ Department of Critical Care, St. Joseph's Health Hospital, Syracuse, NY.
⁵ St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

PMID: 38488422
DOI: 10.1097/CCM.0000000000006251

Abstract

Objectives: To conduct a systematic review and meta-analysis assessing whether the use of antipsychotic medications in critically ill adult patients with delirium impacts patient-important outcomes.

Data sources: A medical librarian searched Ovid MEDLINE, EMBASE, APA PsycInfo, and Wiley's Cochrane Library as well as clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform up to November 2023.

Study selection: Independently and in duplicate, reviewers screened abstracts and titles for eligibility, then full text of qualifying studies. We included parallel-group randomized controlled trials (RCTs) that included critically ill adult patients with delirium. The intervention group was required to receive antipsychotic medications at any dose, whereas the control group received usual care or placebo.

Data extraction: Reviewers extracted data independently and in duplicate using a piloted abstraction form. Statistical analyses were conducted using RevMan software (version 5.4).

Data synthesis: Five RCTs ( n = 1750) met eligibility criteria. The use of antipsychotic medications compared with placebo did not increase the number of delirium- or coma-free days (mean difference 0.90 d; 95% CI, -0.32 to 2.12; moderate certainty), nor did it result in a difference in mortality, duration of mechanical ventilation, ICU, or hospital length of stay. The use of antipsychotics did not result in an increased risk of adverse events (risk ratio 1.27; 95% CI, 0.71-2.30; high certainty). Subgroup analysis of typical versus atypical antipsychotics did not identify any subgroup effect for any outcome.

Conclusions: In conclusion, our systematic review and meta-analysis demonstrated with moderate certainty that there is no difference in delirium- or coma-free days when delirious critically ill adults are treated with antipsychotic medications. Further studies in the subset of patients with hyperactive delirium may be of benefit.