(1001) Evaluation of Quetiapine Monotherapy Versus Quetiapine Plus Oxazepam for ICU Delirium and Agitation

Introduction: Delirium and agitation are common clinical diagnoses in critically ill patients admitted to the intensive care unit (ICU), both associated with increased ICU and hospital length of stay (LOS). Current guidelines do not routinely recommend pharmacotherapy for the treatment or prevention of delirium. Despite this, antipsychotics and benzodiazepines (BZDs) are commonly used for these indications in practice. The purpose of this study was to determine the impact of quetiapine monotherapy versus combination therapy with BZDs on post-extubation ICU LOS in patients experiencing ICU delirium or agitation.

Methods: A retrospective, single-center, cohort study was conducted at a 433-bed tertiary care hospital. Patients included in this study were 18 years or older and admitted to the ICU with subsequent intubation requiring treatment for delirium or agitation. Patients who experienced in-hospital mortality or who underwent tracheostomy were excluded from this study. Those that required reintubation, were on an antipsychotic or BZD prior to admission, or were admitted for COVID-19 were also excluded. Patients were stratified into two groups to assess for differences in post-extubation ICU LOS. Secondary outcomes included post-ICU LOS, total post-extubation LOS, need for an adjunctive treatment agent, maximum quetiapine dose required, and 30-day readmission.

Results: One hundred and eighty-eight patients met inclusion criteria for this study. Baseline characteristics were balanced between groups with the exception of age (66.5 years vs 59.0 years; p< 0.001), Charleson Comorbidity Index (CCI) (5.5 vs 4.0; p=0.001), utilization of insulin drips, and patients admitted with alcohol withdrawal. Post-extubation ICU LOS was 1.3 days longer in the combination therapy group compared to the monotherapy group (5.2 days vs 3.9 days; p=0.022). There were no differences in secondary outcomes between the groups.

Conclusions: ICU delirium and agitation are associated with poor outcomes independent of the pharmacologic agent used for treatment. Post-extubation ICU LOS was shorter in patients who were treated with quetiapine alone for these indications compared to those treated with oxazepam in combination with quetiapine.