Effect of prophylactic perphenazine on delirium after extubation in severe acute pancreatitis

Severe acute pancreatitis (SAP) is a life-threatening condition that can require invasive mechanical ventilation (IMV) to ensure adequate oxygenation and ventilation. However, IMV can cause delirium, a temporary and fluctuating state of consciousness disorder, which negatively impacts patient outcomes. Perphenazine, an antipsychotic drug that blocks dopamine receptors, can alleviate symptoms such as irritability and restlessness that caused by delirium. This retrospective study aimed to identify risk factors associated with delirium in SAP patients after extubation and withdrawal from IMV, and to determine whether prophylactic use of perphenazine could reduce the incidence of delirium.

A total of 40 patients with SAP aged 18-75 years who underwent IMV and were successfully extubated offline after treatment were included. Perphenazine was used consistently 2 mg q12 h for 2 days before extubation. The assessment of delirium began after the removal of the endotracheal tube, using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) every 12 h. Patients were divided into delirium (n = 9) and non-delirium (n = 31) groups or perphenazine (n = 22) and non-perphenazine (n = 18) groups. The clinical data of patients upon admission and after extubation between groups were analyzed using SPSS 26 software. Binary logistic regression was used to evaluate the risk factors for delirium.

Patients with a mean age of 42 years and a male to female ratio of 1.58:1 were enrolled. The incidence of delirium was 22.50%. Univariate analysis (P = 0.025) and binary logistic regression (P = 0.035, 95%CI 0.002-0.762) showed that prophylactic use of perphenazine reduced the incidence of delirium. Fentanyl use was a risk factor for delirium in the univariate analysis (P = 0.039). Patients in the delirium group were hospitalized longer than those in the non-delirium group (P < 0.05).

Perphenazine might have a potential effect on post-extubation delirium in SAP patients.