入住重症监护室时中断家庭精神药物治疗的影响。

Pub Date : 2023-08-01 Epub Date: 2023-06-30 DOI:10.1177/87551225231182286
Jennifer Atherton, Maryam Abdrabbo, Hagar Kassab
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引用次数: 0

摘要

背景:突然停用家庭精神药物在重症患者中很常见,但可能会导致临床上严重的戒断。目的:确定重症监护患者中断家庭精神药物治疗的百分比:确定重症监护病房(ICU)入院时中断家庭精神药物治疗的患者比例,并确定与这些中断治疗相关的结果。研究方法:这是一项由机构审查委员会申请的研究:这是一项经机构审查委员会批准的单中心回顾性研究,研究对象是有精神病史且正在服用抗精神病药或抗抑郁药的重症患者。研究的主要结果是患者入住重症监护室时至少一种家庭精神药物中断用药时间≥24小时的百分比。次要结果包括重新开始服用精神药物的时间、在重症监护室重新开始服用家庭精神药物的百分比、重症监护室住院时间(LOS)、谵妄、戒断相关并发症、急性抗精神病药物或苯二氮卓药物的需求以及精神药物中断的原因。研究结果在183名患者中,93人(50.8%)在入住重症监护室时中断家庭精神药物治疗≥24小时。重新开始使用至少一种精神药物的平均时间为1.4天,16.4%的患者没有重新开始使用任何家用精神药物。中断精神药物治疗的患者在重症监护室的住院时间更长(P = 0.01),重症监护室谵妄的发生率更高(P < 0.01)。各组间与停药相关的并发症相似。精神药物治疗中断患者的急性抗精神病药物用量更大(P < 0.01)。急性苯二氮卓类药物的使用在组间没有差异(P = 0.87)。大多数患者没有中断治疗的记录原因。结论与意义:除非有禁忌症,否则临床医生应尝试尽快为重症患者重新启动家庭精神药物治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Abrupt Interruption of Home Psychotropic Medications at ICU Admission.

Background: Abrupt discontinuation of home psychotropic medications is common among critically ill patients but may precipitate clinically significant withdrawal. Objective: To determine the percent of patients with interruptions in home psychotropic medications upon intensive care unit (ICU) admission and to identify outcomes associated with these interruptions. Methods: This was an institutional review board-approved, single-center, retrospective study of critically ill patients with a history of mental illness taking an antipsychotic or antidepressant medication. The primary outcome was the percent of patients with interruption in at least one home psychotropic medication for ≥24 hours upon ICU admission. Secondary outcomes included time to psychotropic re-initiation, percent of home psychotropic medications restarted in the ICU, ICU length of stay (LOS), delirium, withdrawal-related complications, need for acute antipsychotics or benzodiazepines, and reasons for psychotropic interruption. Results: Among 183 patients, 93 (50.8%) had interruptions in home psychotropic therapy for ≥24 hours upon ICU admission. Mean time to reinitiation of at least one psychotropic agent was 1.4 days, and 16.4% of patients did not have any home psychotropics restarted. Patients with psychotropic interruption had a longer ICU LOS (P = 0.01) and greater incidence of ICU delirium (P < 0.01). Withdrawal-related complications were similar between groups. Acute antipsychotic use was greater in patients with psychotropic interruption (P < 0.01). Acute benzodiazepine use was not different between groups (P = 0.87). Most patients did not have a documented reason for therapy interruption. Conclusion and Relevance: Unless contraindicated, clinicians should attempt to restart home psychotropic medications as soon as possible in critically ill patients.

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