Higher doses of quetiapine prescribed in delirious ECMO supported patients. Can circuit sequestration have a role?

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 .

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.

This record has no associated files available for download.

Contributors

Author: Cathrine McKenzie

Download statistics