772: COMBINATION THERAPY WITH ANTIPSYCHOTIC MEDICATIONS FOR INTENSIVE CARE UNIT DELIRIUM

Abstract

Introduction: Antipsychotic medications continue to be frequently prescribed by clinicians in the intensive care unit (ICU) for the management of acute delirium symptoms, despite inconclusive data. The purpose of this study is to determine if a treatment strategy using a combination of antipsychotic medications reduces the time patients spend in delirium compared with monotherapy. Methods: This was a single-center, retrospective, cohort study of patients 18 years or older. Patients were identified through chart review between January 1, 2020 to July 31,2021 who scored positive on Confusion Assessment Method for the ICU (CAM-ICU) and received antipsychotic therapy. Patients were excluded if they received any antipsychotics prior to hospital admission. Study outcomes included duration of delirium, ICU length of stay (LOS), hospital LOS, overall mortality, occurrence of adverse events (AEs), and whether antipsychotics were continued at hospital discharge. Results: A total of 84 patients were included, of these 38 and 46 received combination therapy and monotherapy, respectively. There were no significant differences in baseline characteristics between groups, except mean Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly higher in the monotherapy group (18.4 vs. 13.6, p< 0.01). Mean duration of delirium was not significantly different between the monotherapy and combination therapy groups (9.4±8.7 days vs. 9.8±8.3 days, p=0.84). Mean hospital LOS (20.7±12.7 days vs 20.9±12.2 days, p=0.95), ICU LOS (14.3±10.5 days vs 13.9±10.5 days, p=0.87), and occurrence of AEs were not significantly different. A significant difference in mortality was found between monotherapy and combination therapy (30.4% vs. 10.5%, p=0.03). Antipsychotics were continued at hospital discharge in 63% of the monotherapy and in 44.7% of the combination therapy group. Conclusions: In patients with ICU delirium, there was no difference in duration of delirium among patients receiving monotherapy compared to combination therapy with antipsychotics, though they may be sicker and have a higher mortality. Patients commonly remain on antipsychotics at hospital discharge, the implications of which warrant further study.