(1595) Quetiapine Use as an Adjunct to IV Sedation in Critically Ill Trauma Patients

Introduction: Quetiapine is frequently used in the Intensive Care Unit (ICU) for delirium treatment and adjunctively in patients with IV sedation requirements. Traumatic brain injury (TBI) patients are typically excluded in descriptions of quetiapine use. This study evaluated our institution’s experience with de-escalation of sedation after quetiapine initiation. We sought to compare characteristics and outcomes in patients who did and did not require IV sedation 72 hours after quetiapine initiation. Additionally, we evaluated quetiapine use in patients with and without TBI.

Methods: This study included patients admitted to a trauma ICU who required mechanical ventilation and received quetiapine between July 1, 2021 and July 1, 2022. Patients who remained on IV sedation/analgesia at 72 hours after initiation of quetiapine (ON sedation) were compared to those who were off sedation/analgesia at 72 hours after initiation (OFF sedation). Demographics and prior medication/psychiatric history were abstracted. Outcomes included need for tracheostomy, vent days, length of stay (LOS), mortality, and discharge disposition. Univariate analyses were also performed for patients with TBI and without TBI evaluating use of quetiapine, IV sedation, and adjuncts.

Results: Of the 181 included patients, 80% were male, 61% had a TBI, 61% required tracheostomy, and median ISS was 22 (IQR:14,29). Median time to tracheostomy was hospital day (HD) 9 and median time to quetiapine was HD 8. 12% of patients were included in the OFF sedation group. There was no difference between ON sedation and OFF sedation in those with TBI (P=0.28), requiring tracheostomy (P=0.813), vent days (P=0.75), LOS (P= 0.59), mortality (P=0.99), or discharge disposition (P=0.43). Patients with TBI were more likely to receive propranolol (17% vs 3%, p=0.004) compared to those without TBI. There was no difference between IV sedation duration in TBI and non TBI.

Conclusions: Quetiapine is used adjunctively at our institution to de-escalate sedation requirements in the trauma ICU setting. There was no difference in tracheostomy requirement, vent days, LOS, mortality, discharge disposition, or TBI between the two study groups after quetiapine initiation. Usage was similar between TBI and non-TBI patient