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Comparative efficacy and acceptability of pharmacological interventions for the treatment and prevention of delirium: A systematic review and network meta-analysis
- Title
- Comparative efficacy and acceptability of pharmacological interventions for the treatment and prevention of delirium: A systematic review and network meta-analysis
- Authors
- Kim, Min Seo; Rhim, Hye Chang; Park, Ariel; Kim, Hanna; Han, Kyu-Man; Patkar, Ashwin A.; Pae, Chi-Un; Han, Changsu
- Ewha Authors
- 김한나
- SCOPUS Author ID
- 김한나
- Issue Date
- 2020
- Journal Title
- JOURNAL OF PSYCHIATRIC RESEARCH
- ISSN
- 0022-3956
1879-1379
- Citation
- JOURNAL OF PSYCHIATRIC RESEARCH vol. 125, pp. 164 - 176
- Keywords
- Network meta-analysis; Delirium; Antipsychotics; Dexmedetomidine; Intensive care unit; Ramelteon
- Publisher
- PERGAMON-ELSEVIER SCIENCE LTD
- Indexed
- SCIE; SSCI; SCOPUS
- Document Type
- Review
- Abstract
- We performed a network meta-analysis to build clear hierarchies of efficacy and tolerability of pharmacological interventions for the treatment and prevention of delirium. Electronic databases including PubMed, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and MEDLINE were searched published up to February 22, 2019. A total of 108 randomized controlled trials (RCTs) investigating pharmacotherapy on delirium were included for analysis, and the strength of evidence (SoE) was evaluated for critical outcomes. In terms of treatment, quetiapine (low SoE), morphine (low SoE), and dexmedetomidine (moderate SoE) were effective in the intensive care unit (ICU) patients. In terms of prevention, dexmedetomidine (high SoE) and risperidone (high SoE) significantly reduced the incidence of delirium in ICU surgical patients, while ramelteon (high SoE) reduced the incidence of delirium in ICU medical patients. Despite the efficacy, dexmedetomidine and risperidone demonstrated higher drop-out rate (moderate to high SoE). Haloperidol and other antipsychotics, except for quetiapine and risperidone, showed no benefit. None of the agents showed benefit in non-ICU patients. In conclusion, dexmedetomidine may be a drug of choice for both treating and preventing delirium of the ICU and postsurgical patients. However, it may be less tolerable, and side-effects should be adequately managed. Current evidence does not support the routine use of antipsychotics. For medical patients, oral ramelteon might be useful for prevention.
- DOI
- 10.1016/j.jpsychires.2020.03.012
- Appears in Collections:
- 연구기관 > 의과학연구소 > Journal papers
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