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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

Authors
Kim, Min SeoRhim, Hye ChangPark, ArielKim, HannaHan, Kyu-ManPatkar, Ashwin A.Pae, Chi-UnHan, Changsu
Issue Date
6월-2020
Publisher
PERGAMON-ELSEVIER SCIENCE LTD
Keywords
Network meta-analysis; Delirium; Antipsychotics; Dexmedetomidine; Intensive care unit; Ramelteon
Citation
JOURNAL OF PSYCHIATRIC RESEARCH, v.125, pp.164 - 176
Indexed
SCIE
SSCI
SCOPUS
Journal Title
JOURNAL OF PSYCHIATRIC RESEARCH
Volume
125
Start Page
164
End Page
176
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/55496
DOI
10.1016/j.jpsychires.2020.03.012
ISSN
0022-3956
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.
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