Pharmacological interventions for prevention and management of delirium in intensive care patients: a systematic overview of reviews and meta-analyses.

Cognition Critical Care / methods Delirium / drug therapy Humans Intensive Care Units Meta-Analysis as Topic Mortality Quality of Life Review Literature as Topic
clinical pharmacology quality in health care

Journal

BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874

Informations de publication

Date de publication:
19 02 2019
Historique:
entrez: 21 2 2019
pubmed: 21 2 2019
medline: 25 2 2020
Statut: epublish

Résumé

We assessed the evidence from reviews and meta-analyses of randomised clinical trials on the effects of pharmacological prevention and management of delirium in intensive care unit (ICU) patients. We searched for reviews in July 2017 in: Cochrane Library, MEDLINE, Embase, Science Citation Index, BIOSIS Previews, CINAHL and LILACS. We assessed whether reviews were systematic according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and assessed the methodological quality using ROBIS. Primary outcomes: all-cause mortality, serious adverse events, prevention of delirium and management of delirium. quality of life; non-serious adverse events and cognitive function. We included 378 reviews: 369 narrative reviews, eight semisystematic reviews which failed on a maximum of two arbitrary PRISMA criteria and one systematic review fulfilling all 27 PRISMA criteria. For the prevention of delirium, we identified the one systematic review and eight semisystematic reviews all assessing the effects of alpha-2-agonists. None found evidence of a reduction of mortality (systematic review RR 0.99, 95% CI 0.79 to 1.24). The systematic review and three semisystematic reviews found no evidence of an effect for the prevention of delirium (systematic review RR 0.85, 0.63 to 1.14). Conversely, four semisystematic reviews found a beneficial effect. Serious adverse events, quality of life, non-serious adverse events and cognitive function were not assessed. We did not identify any systematic or semisystematic reviews addressing other pharmacological interventions for the prevention of delirium. For the management of manifest delirium, we did not identify any systematic or semisystematic review assessing any pharmacological agents. Based on systematic reviews, the evidence for the use of pharmacological interventions for prevention or management of delirium is poor or sparse. A systematic review with low risk of bias assessing the effects of pharmacological prevention of delirium and management of manifest delirium in ICU patients is urgently needed. CRD42016046628.

Identifiants

DOI: 10.1136/bmjopen-2018-024562 PMID: 30782910 PMC: PMC6377549
pubmed: 30782910
pii: bmjopen-2018-024562
doi: 10.1136/bmjopen-2018-024562
pmc: PMC6377549
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

e024562

Informations de copyright

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: MB, MOC, JCJ, AP and JW had financial support from the public Innovation Fund Denmark; AP is head of research at the Dept. of Intensive Care unit at Rigshospitalet. The department receives support for research from CSL Behring, Fresenius Kabi and Ferring Pharmaceuticals. AP and JW are members of the AID-ICU steering group (NCT03392376); no other relationships or activities that could appear to have influenced the submitted work.

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Auteurs

Marija Barbateskovic (M)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Sara Russo Krauss (SR)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Marie Oxenboell Collet (MO)

Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Laura Krone Larsen (LK)

Department of of Neuroanaesthesiology, Rigshospitalet, Copenhagen University hospital, Copenhagen, Denmark.

Janus Christian Jakobsen (JC)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Holbaek Hospital, Holbaek, Denmark.

Anders Perner (A)

Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Jørn Wetterslev (J)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

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Classifications MeSH

questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Cognition › Pharmacological interventions for prevention...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Pharmacological interventions for prevention...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › Pharmacological interventions for prevention...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pharmacological interventions for prevention...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Pharmacological interventions for prevention...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Méta-analyse comme sujet › Pharmacological interventions for prevention...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Pharmacological interventions for prevention...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Pharmacological interventions for prevention...
questionsmedicales.fr › Sciences de l'information › Sources d'information › Moyens de communication › Publications › Littérature de revue comme sujet › Pharmacological interventions for prevention...