Losing Sleep Over Delirium

The Role of Quetiapine in Treating Delirium in Critical Care Settings: A Narrative Review

Delirium is a frequent complication in critically ill patients, often leading to worse clinical outcomes, prolonged ICU stays, and an increased healthcare burden. Its identification has become more consistent with the adoption of validated diagnostic tools, allowing clinicians to recognize and address this condition more effectively. Although delirium can arise from direct neurological dysfunction, it is frequently a consequence of systemic conditions such as sepsis or organ failure. Therefore, a comprehensive evaluation of underlying causes is essential before initiating pharmacological treatment. Among the pharmacological options, quetiapine has gained attention for its use in ICU patients with delirium. Compared to first-generation antipsychotics, it is often preferred due to its sedative effects and more favorable safety. However, current clinical guidelines remain inconclusive regarding its routine use, as evidence supporting its efficacy is limited. One of the main challenges is the heterogeneity of patient populations included in randomized trials, making it difficult to determine whether specific subgroups may benefit more from treatment. This narrative review explores the pharmacological properties of quetiapine, its potential role in managing ICU delirium, and the current state of evidence regarding its safety and effectiveness.

Incidence, associated factors, and outcomes of delirium in critically ill children in china: a prospective cohort study

BACKGROUND

Delirium occurs frequently in critically ill children and has been reported in many countries, but delirium is not well-characterized in China. The aim of this study was to represent the incidence of delirium in critically ill children in China, its associated factors, and the influence of delirium on in-hospital outcomes.

METHODS

This observational prospective cohort study was set up in a large academic medical center with a 57-bed PICU in southwestern China. Critically ill children who required PICU stays over 24 h and were admitted between November 2019 and February 2022 were included in this study. The Cornell Assessment of Pediatric Delirium was used twice daily for delirium evaluation by bedside nurses, and twenty-four clinical features were collected from medical and nursing records during hospitalization.

RESULTS

The incidence of delirium was 26.0% (n = 410/1576). Multivariate analysis revealed that seven independent risk factors including days of mechanical ventilation and physical restraints, admission diagnosis (neurologic disorder), sleep deprivation, use of benzodiazepines and dexmedetomidine, liver failure/liver dysfunction associated with delirium in critically ill children. One potentially protective factor was the watching television /listening to music/playing with toys. Children with delirium had longer lengths of stay in the PICU (median 11 vs. 10 days, p < 0.001) and hospital (median 18 vs. 15 days, p < 0.001) compared to those without delirium. Additionally, the in-hospital mortality rates were 4.63% and 0.77% in patients with and without delirium (p < 0.05).

CONCLUSIONS

Delirium is common in critically ill children in China and related to poor outcomes. Interventional studies are warranted to determine the best practices to reduce delirium exposure in at-risk children.

Towards experimental models of delirium utilizing zebrafish

Delirium is an acute neuropsychiatric condition characterized by impaired behavior and cognition. Although the syndrome has been known for millennia, its CNS mechanisms and risk factors remain poorly understood. Experimental animal models, especially rodent-based, are commonly used to probe various pathogenetic aspects of delirium. Complementing rodents, the zebrafish (Danio rerio) emerges as a promising novel model organism to study delirium. Zebrafish demonstrate high genetic and physiological homology to mammals, easy maintenance, robust behaviors in various sensitive behavioral tests, and the potential to screen for pharmacological agents relevant to delirium. Here, we critically discuss recent developments in the field, and emphasize the developing utility of zebrafish models for translational studies of delirium and deliriant drugs. Overall, the zebrafish represents a valuable and promising aquatic model species whose use may help understand delirium etiology, as well as develop novel therapies for this severely debilitating disorder.