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959: QUETIAPINE AS A SLEEP AID AND THE IMPACT ON DELIRIUM INCIDENCE IN CRITICALLY ILL PATIENTS

Learning Objectives: Data suggest that delirium affects up to 80% of mechanically ventilated adult ICU patients contributing to increased length of stay (LOS), mortality and healthcare costs. Promoting sleep is recommended to improve delirium related outcomes, but data on pharmacologic sleep aids in critically ill patients are lacking. Quetiapine is commonly used at our institution and the purpose of this study is to assess the incidence of delirium when quetiapine is utilized to help promote sleep in critically ill patients. Methods: This single center, retrospective cohort study assessed adult patients who received quetiapine (Q) for at least 48 hours in the MICU, SICU, or CICU with a negative baseline CAM-ICU. A control (C) group selected based on date and unit of admission was also included. The primary endpoint, delirium incidence, was evaluated for patients during a 5-day assessment period. Secondary endpoints included restraint use, ICU LOS, and use of rescue antipsychotics. A sample size of 60 patients per group was selected to provide 80% power with an alpha level of 0.05. Non-parametric data were compared using Mann-Whitney tests and parametric data were compared using t-tests. Normality was assessed using the Kolmogorov and Smirnov method. Results: Demographic characteristics of age (Q 67yrs, C 64 years), gender (Q 27%, C 28% male) and psychiatric history (Q 10%, C 2%) did not differ between groups. APACHE II scores were significantly different (Q 20, C 15; p=0.003). Patients who received quetiapine demonstrated a 15% incidence of delirium compared to 8.3% in the control group (p=0.39) and delirium free days were three in each group. Use of restraints, ICU LOS and rescue antipsychotics were higher in the quetiapine group (60% vs 37%, p=0.017; 6 vs 3, p<0.0001; 30% vs 5%, p<0.0001). Conclusions: In patients with poor sleep patterns and high risk of delirium, the use of quetiapine did not reduce the incidence of delirium as compared to a control group. Due to study design there is inherent selection bias with utilization of quetiapine in patients at high risk for delirium. This potential could have led to differences between groups. Future studies are needed to determine the best pharmacologic sleep aid to promote sleep in critically ill patients.