Abstract

Delirium is an organic dysfunction including the brain’s inflammatory response to injury, hormonal effects and changes in neurotransmission and neural network. Delirium is one of the major causes of weaning difficulty in intensive care unit (ICU) patients. In this case report, we tried to explain the successful weaning procedure in a patient using quetiapine after trying all treatment options due to delirium in the ICU. This report emphasizes that second-generation antipsychotics should be kept in mind in patients who cannot be disconnected from the mechanical ventilator due to delirium.

Keywords: Quetiapine, weaning, delirium

References

  1. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335:1864-9.
  2. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345-55.
  3. Sanders RD. Delirium, neurotransmission, and network connectivity: the search for a comprehensive pathogenic framework. Anesthesiology 2013;118:494-6.
  4. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine 2007;33:66-73.
  5. Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW, et al. Delirium duration and mortality in lightly sedated,mechanically ventilated intensive care patients. Crit Care Med 2010;38:2311-8.
  6. Palencia Herrejon E. Diagnosis of delirium in the critical ill. Medicina Intensiva 2010;34:1-3.
  7. Slutsky AS, Tremblay LN. Multiple system organ failure. Is mechanical ventilation a contributing factor? Am J Resp Crit Care Med 1998;157:1721-5.
  8. Rosenthal LJ, Kim V, Kim DR. Weaning from prolonged mechanical ventilation using an antipsychotic agent in a patient with acute stress disorder. Crit Care Med 2007;35:2417-9.
  9. Navalesi P, Frigerio P, Patzlaff A, Häußermann S, Henseke P, Kubitschek M. Prolonged weaning: from the intensive care unit to home. Rev Port Pneumol 2014;20:264-72.
  10. Dellinger RP. Weaning from mechanical ventilation. In: Vincent JL, editor. Year book of Intensive Care and emergency medicine 1st ed. Heidelberg, CN: Springer-Verlag Berlin; 2006. p. 477-85.
  11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: John Wiley & Sons; 2000.
  12. Trzepacz PT. Is there a final common neural pathway in delirium? focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000;5:132-48.
  13. Al-Samarrai S, Dunn I, Newmark T, Gupta S. Quetiapine for treatment-resistant delirium. Psychosomatics 2003;44:350-1.
  14. Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018;46:825-73.
  15. Swan JT, Fitousis K, Hall JB, Todd SR, Turner KL. Antipsychotic use and diagnosis of delirium in the intensive care unit. Crit Care 2012;16:R84. 
  16. Maneeton B, Maneeton N, Srisurapanont M, Chittawatanarat K. Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial. Drug Des Devel Ther 2013;7:657-67.
  17. Devlin JW, Roberts RJ, Fong JJ, Skrobik Y, Riker RR, Hill NS, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: A prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 2010;38:419-27.
  18. Seemüller F, Volkmer E, Vogel T, Hummel T, Krauseneck T, Riedel M, et al. Quetiapine as Treatment for Delirium During Weaning From Ventilation: A Case Report J Clin Psychopharmacol 2007;27:526-8.
  19. Kim KY, Bader GM, Kotlyar V, Gropper D. Treatment of delirium in older adults with quetiapine. J Geriatr Psychiatry Neurol 2003;16:29-31.
  20. Sue L, Amanda M, Sarah K, Fanny L, Laura B. Impact of Quetiapine Therapy on QTc Prolongation in Critically Ill Patients. Annals of Pharmacotherapy 2019;53:705-10.

Copyright and license

Copyright © 2020 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
İnal MT, Memiş D, Demir ET, Uyar AŞ, Arslan İ, Bozkurtlu P. Simplified Weaning After Use of Quetiapine in a Patient: Case Report. Turk J Intensive Care. 2020;18(3):164-167. https://doi.org/10.4274/tybd.galenos.2020.88598