Quetiapine Twice Daily Versus Bedtime Dosing in the Treatment of ICU Delirium.

Background: Although guidelines recommend twice daily (BID) dosing of quetiapine for treatment of intensive care unit (ICU) delirium in most patients, once daily dosing at bedtime (HS) is commonly prescribed to reduce daytime somnolence. No studies have evaluated differences in outcomes. Objectives: To determine if twice daily vs bedtime dosing of quetiapine reduces the duration of ICU delirium. Methods: Retrospective analysis of ICU patients treated with twice daily vs bedtime dosing of quetiapine for ICU delirium. Health records were analyzed between January 1, 2017, and December 31, 2021. Exclusions included alcohol withdrawal, history of psychiatric conditions requiring medication, receipt of <24 hours of therapy, alternative dosing schedules, and death or transfer from the ICU <24 hours after beginning quetiapine. The primary outcome was recovery of delirium per Confusion Assessment Method (CAM-ICU). Secondary outcomes included lengths of stay, mechanical ventilation duration, in-hospital death, and QTc prolongation. Results: Baseline characteristics differed for sex (30.4% vs 61.1% female) and admission diagnosis (39% vs. 17% COVID-19, respectively). Time to delirium recovery was 3.5 days for BID vs 2.5 days for QHS dosing (P = .484). Secondary outcomes of ICU (16 vs. 19 days) and hospital (22 vs. 25 days) lengths of stay, duration of mechanical ventilation (10 vs. 14), delirium recovery (70% vs. 56%), in-hospital death (61% vs. 50%), and QTc prolongation did not differ significantly between groups. Conclusions: Twice daily vs bedtime dosing of quetiapine did not significantly alter delirium outcomes, suggesting similar efficacy. Larger sample sizes are needed to confirm these results.

The pharmacist's role in reducing infusion-related phlebitis.

PURPOSE: Pharmacists oversee parenteral drug preparation and administration in hospitals, clinics, infusion centers, and home infusion settings. Infusion-related phlebitis (IRP), the most common complication of intravenous infusion therapy, significantly impacts therapeutic outcomes, patient satisfaction, cost of care, and provider workload. Here we review the major etiologies of IRP and describe potential pharmacological and nonpharmacological interventions for preventing and managing the condition as well as for improving vascular access health in multiple-drug administration settings. SUMMARY: Many parenterally administered drugs cause phlebitis due to mechanical, chemical, or infectious etiologies. Pharmacists can recommend nonpharmacological strategies to mitigate phlebitis, including -judicious device selection and placement; adjustment of the drug concentration, flow rate, or formulation; infusion site rotation; and use of inline filters to minimize contaminant particulates. Pharmacological treatments for phlebitis include topical, local, and systemic anti-inflammatory and analgesic agents that can reduce symptom severity and prevent further treatment complications or delays. CONCLUSION: Pharmacists can contribute a unique perspective to interprofessional teams tasked with making policy and formulary decisions that minimize the negative impacts of IRP on drug delivery and patient outcomes.