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Short-Term Effect of Quetiapine Used to Treat Delirium Symptoms on Opioid and Benzodiazepine Requirements in the Pediatric Cardiac Intensive Care Unit


Opioids or benzodiazepines use is known to increase the risk of delirium. The prevalence of delirium is high in pediatric cardiac intensive care units (CICUs) with associated morbidity and mortality. We investigate the short-term effects of quetiapine, an atypical antipsychotic medication, on opioid and benzodiazepine requirements, and any associated adverse events as we utilize quetiapine to treat delirium symptoms in this single-center, retrospective study. Twenty-eight patients who received quetiapine between January 2018 and June 2019 in the CICU met inclusion criteria for the analysis. The quetiapine initiation dose was 0.5 mg/kg/dose every 8 h and we allowed 48 h for quetiapine to reach a steady state. Overall opioid and benzodiazepine requirements were compared 72 h before and 72 h after the quetiapine steady state. There was a statistically significant reduction in the total daily opioid (p = 0.001) and benzodiazepine (p = 0.01) amounts following quetiapine initiation. There was also a statistically significant decrease in the total number of daily PRNs requirement for both opioids (p < 0.001) and benzodiazepines (p = 0.03). Nine out of 13 patients were completely weaned off continuous opioid drips following quetiapine initiation (p = 0.01). The presence of steady-state habituation medications, including methadone or lorazepam, did not have any statistically significant effect on weaning continuous opioid (p = 0.18) or benzodiazepine (p = 0.62) drips. There was no statistically significant effect of quetiapine on the QTc interval after quetiapine initiation (p = 0.58) with no clinically significant arrhythmias observed during the study period. Our study demonstrates a statistically significant reduction in opioid and benzodiazepine requirements following quetiapine initiation to treat delirium symptoms without significant adverse effects in patients with congenital heart disease in the short term.

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  1. Alvarez RV, Palmer C, Czaja AS, Peyton C, Silver G, Traube C, Mourani PM, Kaufman J (2018) Delirium is a common and early finding in patients in the pediatric cardiac intensive care unit. J Pediatr 195:206–212

    Article  Google Scholar 

  2. Feroz S, Donnelly KM (2019) Not just to survive but to thrive: delirium in the pediatric cardiac ICU. Curr Opin Cardiol.

    Article  Google Scholar 

  3. Patel AK, Biagas KV, Clarke EC, Gerber LM, Mauer E, Silver G, Chai P, Corda R, Traube C (2017) Delirium in children after cardiac bypass surgery. Pediatr Crit Care Med 18(2):165–171

    Article  Google Scholar 

  4. Staveski SL, Pickler RH, Khoury PR, Ollberding NJ, Donnellan AL, Mauney JA, Lincoln PA, Baird JD, Gilliland FL, Merritt AD et al (2021) Prevalence of ICU delirium in postoperative pediatric cardiac surgery patients. Pediatr Crit Care Med 22(1):68–78

    Article  Google Scholar 

  5. Silver G, Traube C, Gerber LM, Sun X, Kearney J, Patel A, Greenwald B (2015) Pediatric delirium and associated risk factors: a single-center prospective observational study. Pediatr Crit Care Med 16(4):303–309

    Article  Google Scholar 

  6. American Psychiatric Association (2013) DSM-5 task force: diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Association, Washington

    Book  Google Scholar 

  7. Thom RP, Levy-Carrick NC, Bui M, Silbersweig D (2019) Delirium. Am J Psychiatry 176(10):785–793

    Article  Google Scholar 

  8. Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, Halpert S, Augenstein J, Sickles LE, Li C et al (2014) Cornell assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med 42(3):656–663

    Article  Google Scholar 

  9. Valdivia HR, Carlin KE (2019) Determining interrater reliability of the cornell assessment of pediatric delirium screening tool among PICU nurses. Pediatr Crit Care Med 20(4):e216–e220

    Article  Google Scholar 

  10. Groves A, Traube C, Silver G (2016) Detection and management of delirium in the neonatal unit: a case series. Pediatrics 137(3):e20153369

    Article  Google Scholar 

  11. Traube C, Witcher R, Mendez-Rico E, Silver G (2013) Quetiapine as treatment for delirium in critically ill children: a case series. J Pediatr Intensive Care 2(3):121–126

    PubMed  PubMed Central  Google Scholar 

  12. Brahmbhatt K, Whitgob E (2016) Diagnosis and management of delirium in critically ill infants: case report and review. Pediatrics 137(3):e20151940

    Article  Google Scholar 

  13. Amirnovin R, Sanchez-Pinto LN, Okuhara C, Lieu P, Koh JY, Rodgers JW, Nelson LP (2018) Implementation of a risk-stratified opioid and benzodiazepine weaning protocol in a pediatric cardiac ICU. Pediatr Crit Care Med 19(11):1024–1032

    Article  Google Scholar 

  14. Bryant KJ (2018) Pediatric delirium in the cardiac intensive care unit: identification and intervention. Crit Care Nurse 38(4):e1–e7

    Article  Google Scholar 

  15. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM et al (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41(1):263–306

    Article  Google Scholar 

  16. Devlin JW, Roberts RJ, Fong JJ, Skrobik Y, Riker RR, Hill NS, Robbins T, Garpestad E (2010) Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 38(2):419–427

    CAS  Article  Google Scholar 

  17. Joyce C, Witcher R, Herrup E, Kaur S, Mendez-Rico E, Silver G, Greenwald BM, Traube C (2015) Evaluation of the safety of quetiapine in treating delirium in critically ill children: a retrospective review. J Child Adolesc Psychopharmacol 25(9):666–670

    CAS  Article  Google Scholar 

  18. Mireskandari SM, Abulahrar N, Darabi ME, Rahimi I, Haji-Mohamadi F, Movafegh A (2011) Comparison of the effect of fentanyl, sufentanil, alfentanil and remifentanil on cardiovascular response to tracheal intubation in children. Iran J Pediatr 21(2):173–180

    PubMed  PubMed Central  Google Scholar 

  19. Turkel SB, Jacobson J, Munzig E, Tavare CJ (2012) Atypical antipsychotic medications to control symptoms of delirium in children and adolescents. J Child Adolesc Psychopharmacol 22(2):126–130

    CAS  Article  Google Scholar 

  20. Nikooie R, Neufeld KJ, Oh ES, Wilson LM, Zhang A, Robinson KA, Needham DM (2019) Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med 171(7):485–495

    Article  Google Scholar 

  21. Dube KM, DeGrado J, Hohlfelder B, Szumita PM (2018) Evaluation of the effects of quetiapine on QTc prolongation in critically ill patients. J Pharm Pract 31(3):292–297

    Article  Google Scholar 

  22. Smeets IA, Tan EY, Vossen HG, Leroy PL, Lousberg RH, van Os J, Schieveld JN (2010) Prolonged stay at the paediatric intensive care unit associated with paediatric delirium. Eur Child Adolesc Psychiatry 19(4):389–393

    Article  Google Scholar 

  23. Smith HA, Berutti T, Brink E, Strohler B, Fuchs DC, Ely EW, Pandharipande PP (2013) Pediatric critical care perceptions on analgesia, sedation, and delirium. Semin Respir Crit Care Med 34(2):244–261

    Article  Google Scholar 

  24. Chomat MR, Said AS, Mann JL, Wallendorf M, Bickhaus A, Figueroa M (2021) Changes in sedation practices in association with delirium screening in infants after cardiopulmonary bypass. Pediatr Cardiol 42(6):1334–1340

    Article  Google Scholar 

  25. Jiang L, Ding S, Yan H, Li Y, Zhang L, Chen X, Yin X, Liu S, Tang X, Zhang J (2015) A retrospective comparison of dexmedetomidine versus midazolam for pediatric patients with congenital heart disease requiring postoperative sedation. Pediatr Cardiol 36(5):993–999

    Article  Google Scholar 

  26. Chuen VL, Chan ACH, Ma J, Alibhai SMH, Chau V (2021) The frequency and quality of delirium documentation in discharge summaries. BMC Geriatr 21(1):307

    Article  Google Scholar 

  27. Daoud A, Duff JP, Joffe AR, Alberta Sepsis N (2014) Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care 18(5):489

    Article  Google Scholar 

  28. Ely EW, Siegel MD, Inouye SK (2001) Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction. Semin Respir Crit Care Med 22(2):115–126

    CAS  Article  Google Scholar 

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JT and WK designed the study, collected data, performed data analysis, and wrote/reviewed the manuscript. JS and JZ collected data and reviewed the manuscript. BH performed data analysis and reviewed the manuscript. DC designed the study and reviewed the manuscript.

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Correspondence to Wonshill Koh.

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Thielen, J.R., Sawyer, J.E., Henry, B.M. et al. Short-Term Effect of Quetiapine Used to Treat Delirium Symptoms on Opioid and Benzodiazepine Requirements in the Pediatric Cardiac Intensive Care Unit. Pediatr Cardiol (2022).

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  • Quetiapine
  • Delirium
  • Congenital heart disease
  • Cardiac intensive care
  • Agitation
  • Opioid
  • Benzodiazepine