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Implications of atypical antipsychotic prescribing in the intensive care unit.

Publication ,  Journal Article
Kram, BL; Kram, SJ; Brooks, KR
Published in: J Crit Care
August 2015

PURPOSE: The purpose of the study was to determine the downstream implications of atypical antipsychotic (AAP) prescribing in the intensive care unit (ICU), including discharge prescribing practices, monitoring, and attributable adverse drug events. MATERIALS AND METHODS: This retrospective cohort study included patients at least 18 years of age admitted to an ICU that received at least 2 doses of an AAP for documented delirium or avoidance of a deliriogenic medication. Exclusion criteria were documentation of an AAP as a home medication or initiation for a psychiatric indication unrelated to delirium (eg, schizophrenia). RESULTS: During the 8-month study period, 156 patients were included and 133 (85.2%) patients survived to hospital discharge. Of the survivors, AAP therapy was continued for 112 (84.2%) patients upon ICU transfer and for 38 (28.6%) patients upon hospital discharge. A majority of these patients had evidence of delirium resolution or no indication for continuation documented at discharge. Of the 127 patients with an electrocardiogram ordered during AAP therapy, QTc prolongation occurred in 49 (31.4%) patients. An adverse drug event leading to drug discontinuation was documented in 16 (10.2%) patients. CONCLUSIONS: Because of significant patient-centered implications, AAPs initiated in the ICU require continued evaluation for indication to avoid prolonged and possibly unnecessary use.

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Published In

J Crit Care

DOI

EISSN

1557-8615

Publication Date

August 2015

Volume

30

Issue

4

Start / End Page

814 / 818

Location

United States

Related Subject Headings

  • Thiazoles
  • Survivors
  • Risperidone
  • Retrospective Studies
  • Quetiapine Fumarate
  • Piperazines
  • Patient Discharge
  • Olanzapine
  • Middle Aged
  • Male
 

Citation

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Kram, B. L., Kram, S. J., & Brooks, K. R. (2015). Implications of atypical antipsychotic prescribing in the intensive care unit. J Crit Care, 30(4), 814–818. https://doi.org/10.1016/j.jcrc.2015.03.030
Kram, Bridgette L., Shawn J. Kram, and Kelli R. Brooks. “Implications of atypical antipsychotic prescribing in the intensive care unit.J Crit Care 30, no. 4 (August 2015): 814–18. https://doi.org/10.1016/j.jcrc.2015.03.030.
Kram BL, Kram SJ, Brooks KR. Implications of atypical antipsychotic prescribing in the intensive care unit. J Crit Care. 2015 Aug;30(4):814–8.
Kram, Bridgette L., et al. “Implications of atypical antipsychotic prescribing in the intensive care unit.J Crit Care, vol. 30, no. 4, Aug. 2015, pp. 814–18. Pubmed, doi:10.1016/j.jcrc.2015.03.030.
Kram BL, Kram SJ, Brooks KR. Implications of atypical antipsychotic prescribing in the intensive care unit. J Crit Care. 2015 Aug;30(4):814–818.
Journal cover image

Published In

J Crit Care

DOI

EISSN

1557-8615

Publication Date

August 2015

Volume

30

Issue

4

Start / End Page

814 / 818

Location

United States

Related Subject Headings

  • Thiazoles
  • Survivors
  • Risperidone
  • Retrospective Studies
  • Quetiapine Fumarate
  • Piperazines
  • Patient Discharge
  • Olanzapine
  • Middle Aged
  • Male