Higher doses of quetiapine prescribed in delirious ECMO supported patients. Can circuit sequestration have a role?
Higher doses of quetiapine prescribed in delirious ECMO supported patients. Can circuit sequestration have a role?
Delirium is the most common neuropsychiatric condition in critical care. It can affect up to 80%of mechanically ventilatedpatients. Antipsychotics (APs) are the most frequently prescribed medication for the management of delirium symptoms in criticalcare.We have conducted an extensive retrospective review that was focused on antipsychotics prescribing patterns for managementdelirium over 4 months period. In the review, 6 patients receiving ECMO VV (venovenous) support, were prescribed quetiapinefor delirium management.ECMO supported patients often have a greater severity of illness, multiple comorbidities, and require a greater depth of sedation(especially in the short term). This can increase both delirium development and severity(1) which can ultimately result inprescribing higher APs doses to achieve the desired effect. Although, an additional explanation for higher doses is that quetiapinecould have been sequestrated by the ECMO circuit.ECMO circuits drug sequestration is a well prescribed phenomenon. Ex-vivo studies (2) have concluded that concentration ofhighly protein bound and/ or lipophilic drugs (quetiapine is both) may be lower in ECMO supported patients. This could potentiallylead to pseudo resistance which can be overcome by prescribing higher doses.
Almehari, Eiman
9a54bd8c-3744-4edb-8a05-b4938acc8788
Davis, Graham
251cb2a4-a103-4572-ba2f-b7ee0b4dd8be
Barrett, Nicholas A.
82ac972d-7f3d-47b5-9ab5-9b1fc34830dd
McKenzie, Cathrine
ec344dee-5777-49c5-970e-6326e82c9f8c
2018
Almehari, Eiman
9a54bd8c-3744-4edb-8a05-b4938acc8788
Davis, Graham
251cb2a4-a103-4572-ba2f-b7ee0b4dd8be
Barrett, Nicholas A.
82ac972d-7f3d-47b5-9ab5-9b1fc34830dd
McKenzie, Cathrine
ec344dee-5777-49c5-970e-6326e82c9f8c
Almehari, Eiman, Davis, Graham, Barrett, Nicholas A. and McKenzie, Cathrine
(2018)
Higher doses of quetiapine prescribed in delirious ECMO supported patients. Can circuit sequestration have a role?
7th EuroELSO Congress on ECMO-ECLS, , Prague, Czech Republic.
23 - 26 May 2018.
2 pp
.
Record type:
Conference or Workshop Item
(Poster)
Abstract
Delirium is the most common neuropsychiatric condition in critical care. It can affect up to 80%of mechanically ventilatedpatients. Antipsychotics (APs) are the most frequently prescribed medication for the management of delirium symptoms in criticalcare.We have conducted an extensive retrospective review that was focused on antipsychotics prescribing patterns for managementdelirium over 4 months period. In the review, 6 patients receiving ECMO VV (venovenous) support, were prescribed quetiapinefor delirium management.ECMO supported patients often have a greater severity of illness, multiple comorbidities, and require a greater depth of sedation(especially in the short term). This can increase both delirium development and severity(1) which can ultimately result inprescribing higher APs doses to achieve the desired effect. Although, an additional explanation for higher doses is that quetiapinecould have been sequestrated by the ECMO circuit.ECMO circuits drug sequestration is a well prescribed phenomenon. Ex-vivo studies (2) have concluded that concentration ofhighly protein bound and/ or lipophilic drugs (quetiapine is both) may be lower in ECMO supported patients. This could potentiallylead to pseudo resistance which can be overcome by prescribing higher doses.
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Published date: 2018
Venue - Dates:
7th EuroELSO Congress on ECMO-ECLS, , Prague, Czech Republic, 2018-05-23 - 2018-05-26
Identifiers
Local EPrints ID: 479771
URI: http://eprints.soton.ac.uk/id/eprint/479771
PURE UUID: 12f43b09-8f82-4e5c-a1bd-3eaac7aab583
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Date deposited: 26 Jul 2023 17:00
Last modified: 20 Dec 2023 03:12
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Contributors
Author:
Eiman Almehari
Author:
Graham Davis
Author:
Nicholas A. Barrett
Author:
Cathrine McKenzie
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