Psychotropic medication in children in a tertiary paediatric intensive care unit-A single-centre retrospective study

Psychotropic medications are used in children in intensive care for a range of indications, yet their patterns of use are not well described. We aimed to describe the timing, dose, duration, and annual trends in psychotropic medication use in children admitted to a single-centre paediatric intensive care unit (PICU).

A retrospective cohort study was performed at the Royal Children's Hospital PICU between 1 January 2017 and 31 December 2024. Children less than 18 years of age who initiated an antipsychotic or antidepressant medication during their PICU admission were included in the study. We described the clinical characteristics of children, psychotropic characteristics, and annual patterns of use.

There were 504 of 11 450 (4.4%) admissions in 455 children who received psychotropic medications during the study period. Antipsychotics alone were administered in 447 of 504 (88.7%) admissions, antidepressants alone in 40 of 504 (7.9%), and both classes in 17 of 504 (3.4%). Children who received psychotropic medications were older (10 years [interquartile range {IQR}: 5-14] vs 1 year [IQR: 0-6]), had slightly higher admission illness severity (Paediatric Index of Mortality: 1.6 [IQR: 0.5, 4.1] vs 1.1 [IQR: 0.3, 2.4]; p < 0.001), and experienced a greater PICU length of stay (6.7 days [IQR: 2.0, 19.0] vs 2.0 days [IQR: 1.0, 4.6]; p < 0.001). Olanzapine and amitriptyline were the most commonly prescribed medications within each class. In 69% of admissions, the duration was ≤1 week. The annual rate of psychotropic administration varied between 2.8 and 5.5% during the study period, and continuation after hospital discharge was uncommon (6.5%).

Psychotropic medications were used in 4.4% of admissions to a single-centre PICU, commonly in older children and predominantly antipsychotics for short duration. The annual use remained constant, suggesting established administration practices. These findings highlight the need to investigate the use of psychotropic medications further in critically ill children.