Recommendation Should an atypical antipsychotic vs. no such strategy be used in critically ill adults WITH delirium? Balance of Undesirable Undesirable consequences The balance between Desirable consequences Desirable consequences consequences desirable and undesirable consequences clearly probably outweigh probably outweigh clearly outweigh desirable desirable consequences in consequences undesirable consequences undesirable consequences outweigh is closely consequences in most most settings in most settings in most settings balanced or uncertain settings ○ ○ ● ○ ○ Type of recommendation We recommend against We suggest not offering We suggest offering this We recommend offering this option offering this option this option option ○ ● ○ ○ Recommendation We do not suggest using atypical antipsychotics for delirium in critically ill patients. Justification We have moderate evidence that atypical antipsychotic use is not associated with a decreased ICU length of stay. We have low certainty about the effect of atypical antipsychotics on delirium duration or duration of ventilation or mortality, but given the lack of demonstrated benefit patients should not routinely be exposed to potential harms associated with these medications. Subgroup considerations Patients who experience significant distress secondary to symptoms of an episode of delirium such as anxiety, fearfulness, hallucinations, or delusions or who may be physically threatening to self or others may benefit from the use of lowest effective doses of atypical antipsychotics for symptomatic relief. Atypical antipsychotics should be discontinued following the resolution of the patient's distress. Research possibilities More research is needed on the benefit of atypical antipsychotics in treating distress due to delirium symptoms, longer term outcomes after critical illness and system innovations to ensure that patients do not remain on antipsychotics indefinitely following symptomatic initiation during a delirium episode. Comments during electronic Clinically atypicals reduce delirium in some patients, perhaps at the cost of & risk of AEs and complications. ↑sedation voting by entire panel perhaps recommendation". Maybe part of the problem is that not all delirium is the same. "Routine" use of these drugs “no may not be indicated but considered if agitation, hallucinations, etc.
Recommendation Should an atypical antipsychotic vs. no such strategy be used in critically ill adults WITH delirium? Balance of consequences Undesirable consequences clearly outweigh desirable consequences in most settings Undesirable consequences probably outweigh desirable consequences in most settings The balance between desirable and undesirable consequences is closely balanced or uncertain Desirable consequences probably outweigh undesirable consequences in most settings Desirable consequences clearly outweigh undesirable consequences in most settings ○ ○ ● ○ ○ Type of recommendation We recommend against offering this option We suggest not offering this option We suggest offering this option We recommend offering this option ○ ● ○ ○ Recommendation We do not suggest using atypical antipsychotics for delirium in critically ill patients. Justification We have moderate evidence that atypical antipsychotic use is not associated with a decreased ICU length of stay. We have low certainty about the effect of atypical antipsychotics on delirium duration or duration of ventilation or mortality, but given the lack of demonstrated benefit patients should not routinely be exposed to potential harms associated with these medications. Subgroup considerations Patients who experience significant distress secondary to symptoms of an episode of delirium such as anxiety, fearfulness, hallucinations, or delusions or who may be physically threatening to self or others may benefit from the use of lowest effective doses of atypical antipsychotics for symptomatic relief. Atypical antipsychotics should be discontinued following the resolution of the patient's distress. Research possibilities More research is needed on the benefit of atypical antipsychotics in treating distress due to delirium symptoms, longer term outcomes after critical illness and system innovations to ensure that patients do not remain on antipsychotics indefinitely following symptomatic initiation during a delirium episode. Comments during electronic voting by entire panel Clinically atypicals reduce delirium in some patients, perhaps at the cost of ↑sedation & risk of AEs and complications. perhaps “no recommendation". Maybe part of the problem is that not all delirium is the same. "Routine" use of these drugs may not be indicated but considered if agitation, hallucinations, etc.
CCM_46_9_2018_06_08_DEVLIN_CCMED-D-18-00069_SDC26.docx