Antipsychotic Use for ICU Delirium and Associated Inflammatory Markers

Area of Science:

• Critical care medicine
• Neuroscience
• Immunology

Background:

• Delirium is common in critically ill patients.
• Inflammatory cytokines may play a role in delirium pathogenesis.
• The efficacy of antipsychotics in managing delirium and inflammation is unclear.

Purpose of the Study:

• To evaluate inflammatory cytokine (IL-6, IL-8) production in critically ill patients with delirium.
• To assess the relationship between cytokine levels, delirium progression, and antipsychotic use.
• To identify patient characteristics associated with different inflammatory profiles and outcomes.

Main Methods:

• Prospective, observational cohort study of adult critically ill patients with delirium (positive CAM-ICU score).
• Trended Interleukin-6 (IL-6) and Interleukin-8 (IL-8) levels for 24 hours.
• Analyzed patient clusters based on age, severity of illness (APACHE III), mechanical ventilation, and infection, comparing antipsychotic exposure and inflammatory markers.

Main Results:

• No significant difference in IL-6 and IL-8 levels based on antipsychotic exposure.
• Identified two patient clusters with differing inflammatory conditions and baseline cytokine levels.
• Cluster 1 patients, with more co-inflammatory conditions, had numerically lower IL-6/IL-8 and more delirium-free days (17.0 vs 6.0).

Conclusions:

• Interleukin-6 and Interleukin-8 levels in critically ill patients with delirium are variable.
• Antipsychotic administration was not associated with improved delirium outcomes or reduced inflammatory markers.
• Patient clustering suggests distinct inflammatory profiles may influence delirium duration in critical illness.