Are dexmedetomidine and olanzapine suitable to control delirium in critically ill elderly patients? A retrospective cohort study,Biomedicine & Pharmacotherapy

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Are dexmedetomidine and olanzapine suitable to control delirium in critically ill elderly patients? A retrospective cohort study
Biomedicine & Pharmacotherapy ( IF 6.9 ) Pub Date : 2021-04-26 , DOI: 10.1016/j.biopha.2021.111617
SiBo Liu ₁ , Rui Zhao ₂ , RongLi Yang ₂ , HongLing Zhao ₃ , ChenHua Ji ₄ , MeiLi Duan ₅ , JinJie Liu ₃

Affiliation

Background

The efficacy and safety of dexmedetomidine and olanzapine for delirium control in critically ill elderly patients without ventilation or surgery are not known.

Methods

The efficacy and safety of dexmedetomidine and olanzapine for controlling delirium were evaluated in a retrospective cohort of critically illness by assessing the sedation level, drug dose/duration, combination rate with other sedatives, adverse effects, intubation rate and prognosis.

Result

The maximum (1.61 ± 1.56 vs. 2.70 ± 1.01, p < 0.001), average (−0.57 ± 0.88 vs. 0.88 ± 0.73, p < 0.001), and minimum (−1.67 ± 1.04 vs. −1.37 ± 1.01, p = 0.014) RASS scores of 263 patients were lower after treating with dexmedetomidine than treating with olanzapine. Drug use duration (4.83 ± 2.67 days vs. 5.87 ± 3.14 days, p = 0.005) and sedative combination rates (13.56% vs. 40.00%, p = 0.003) were lower when treating with dexmedetomidine than that with olanzapine. A comparison of adverse effects between dexmedetomidine and olanzapine revealed respiratory depression (16.95% vs. 2.84%, p < 0.001), hypoxia (13.56% vs. 2.76%, p < 0.001) and hypotension (11.02% vs. 3.45%, p = 0.007). Intubation rates (22.88% vs. 12.41%, p = 0.023) and the length of hospital stay (9.30 ± 4.90 days vs. 8.83 ± 3.34 days, p < 0.001) were higher in patients treated with dexmedetomidine than that with olanzapine. Mortality rates, cognitive prognosis, and delirium recurrence rates were similar between groups. Age, severe cardiopulmonary disease, APACHE II scores, dexmedetomidine dose, minimum RASS score and sedative combination were significantly (p < 0.05) associated with the adverse effects of dexmedetomidine. Respiratory depression, hypoxia and hypotension in the olanzapine group all occurred during combination with benzodiazepines.

Conclusions

Dexmedetomidine achieved more satisfactory sedative effects on delirium control, but olanzapine was safer.

中文翻译：

右美托咪定和奥氮平是否适合控制重症老年患者的del妄？回顾性队列研究

背景

右美托咪定和奥氮平在没有通气或手术的重症老年患者中控制del妄的功效和安全性尚不清楚。

方法

在回顾性危重疾病队列中，通过评估镇静水平，药物剂量/持续时间，与其他镇静剂的联合使用率，不良反应，插管率和预后，评估了右美托咪定和奥氮平控制del妄的有效性和安全性。

结果

最大值（1.61±1.56对2.70±1.01，p <0.001），平均值（-0.57±0.88对0.88±0.73，p <0.001）和最小值（-1.67±1.04对−1.37±1.01，p = 0.014）右美托咪定治疗后263例患者的RASS评分低于奥氮平治疗。右美托咪定治疗的药物使用时间（4.83±2.67天vs. 5.87±3.14天，p = 0.005）和镇静剂联合使用率（13.56％vs. 40.00％，p = 0.003）低于奥氮平。比较右美托咪定和奥氮平的不良反应，发现呼吸抑制（16.95％vs.2.84％，p <0.001），缺氧（13.56％vs. 2.76％，p <0.001）和低血压（11.02％vs. 3.45％，p = 0.007）。插管率（22.88％vs. 12.41％，p = 0.023）和住院时间（9.30±4.90天vs. 8.83±3.34天，p <0。右美托咪定治疗的患者比奥氮平治疗的患者高001）。两组之间的死亡率，认知预后和del妄复发率相似。年龄，严重心肺疾病，APACHE II评分，右美托咪定剂量，最低RASS评分和镇静剂联合与右美托咪定的不良反应显着相关（p <0.05）。奥氮平组与苯二氮卓类药物合用时均出现呼吸抑制，低氧和低血压。05）与右美托咪定的不良反应有关。奥氮平组与苯二氮卓类药物合用时均出现呼吸抑制，低氧和低血压。05）与右美托咪定的不良反应有关。奥氮平组与苯二氮卓类药物合用时均出现呼吸抑制，低氧和低血压。