From the Authors:
We thank Dr. Song for his questions regarding our article. In our cohort, a larger proportion of delirious patients received antipsychotics (i.e., haloperidol and risperidone) compared with nondelirious patients (33% vs. 5%; P < 0.001) (1). Because the timing of antipsychotic administration relative to the development of delirium was not measured, we cannot comment on the relationship between antipsychotic use and the severity and duration of delirium.
Although longer-term use of typical and atypical antipsychotics in older patients with dementia-related psychosis has been associated with an increased risk for sudden cardiac death (2–4), short-term antipsychotic use in the intensive care unit (ICU) and in perioperative settings has been shown to be safe (5–7). Furthermore, as Dr. Song indicated, limited evidence suggests that administration of antipsychotics to critically ill patients may improve clinical outcomes (7, 8). We did not find an association between antipsychotics and in-hospital mortality in bivariate analyses, and the addition of antipsychotic use to our multivariate model did not significantly alter the associations among acute respiratory distress syndrome, ICU delirium and coma, and in-hospital mortality. Modifying the Impact of ICU-Associated Neurological Dysfunction-USA (MIND-USA; www.clinicaltrials.gov, NCT 01211522), an ongoing large, multicenter, randomized placebo-controlled trial, will hopefully provide more definitive answers regarding the efficacy and safety of typical and atypical antipsychotics for the treatment of ICU delirium.
Footnotes
Supported by National Institute on Aging grant R03AG040673 and Albert Einstein College of Medicine–Montefiore Medical Center Institute for Clinical and Translational Research grant 8KL2TR0000088-05 (S.J.H.); NHLBI grants HL084060 and HL086667 (M.N.G.); and 1 UL1 TR001073-01, 1 TL1 TR001072-01, and 1 KL2 TR001071-01 (Einstein-Montefiore Clinical and Translational Science Award).
Author disclosures are available with the text of this letter at www.atsjournals.org.
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