Is Quetiapine Safe and Effective for Pediatric ICU Delirium? AReal-World Meta-Analysis
Main Article Content
Keywords
Pediatric intensive care, Delirium, Quetiapine, Atypical antipsy
Abstract
Background:Delirium in pediatric intensive care units (PICUs) is a significant neuropsychiatric condition that affects consciousness, attention, cognition, and perception. Its management is crucial due to its high incidence and potential severe outcomes.Objective: This review aims to evaluate the safety and efficacy of quetiapine, an atypical antipsychotic, in managing pediatric delirium within PICUs, given its prevalent use in adults and emerging application in pediatric settings.Methods: A systematic literature search was conducted across databases, including PubMed, Cochrane Library, EMBASE, and Scopus, with no restriction on publication date. Studies were selected based on their focus on the safety and efficacy of quetiapine in pediatric delirium management. Data extraction and synthesis were performed, pooling quantitative data for meta-analysis and assessing study quality and bias using standardized tools. Results: The literature search yielded six studies suitable for inclusion, encompassing randomized controlled trials and observational studies. Quetiapine was generally well tolerated, with few serious side effects, such as QTc prolongation and metabolic issues. Efficacy outcomes were mixed, with some studies reporting reduced symptoms and duration of delirium. In contrast, others indicated no significant improvement compared to other treatments or placebo.Conclusions: Quetiapine shows potential for managing pediatric delirium in PICUs, with a safety profile that is acceptable in short-term use. However, the evidence is inconclusive regarding its overall efficacy in reducing delirium incidence and duration. More robust, controlled trials are needed to establish clear guidelines and assess long-term safety and efficacy.
References
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12. Ravindran AV, Al-Subaie A, Abraham G. Quetiapine: novel uses in the treatment of depressive and anxiety disorders. Expert Opin Investig Drugs. 2010;19(10):1187-204.
13. Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychia- try. 2018;33(11):1428-57.
14. Maldonado JR. Inflammatory biomarkers and neurotransmitter perturbations in delirium. In: Delirium: acute brain dysfunc- tion in the critically ill. Cham: Springer; 2020. p. 135-67.
15. Zhu X, Feng X, Lin J, Ding Y. Risk factors of delirium in paediatric intensive care units: a meta-analysis. PLoS One. 2022;17(7):e0270639.
16. Kato T, Thie NM, Huynh N, Miyawaki S, Lavigne GJ. Topical review: sleep bruxism and the role of peripheral sensory influenc- es. J Orofac Pain. 2003;17(3):191-213.
17. Kirby J. Neurobiological bases of the use of atypical antipsychotics in treatment-resistant major depressive disorder [disserta- tion]. Ottawa: University of Ottawa; 2018.
18. Poyurovsky M, Weizman A. Treatment of antipsychotic-induced akathisia: role of serotonin 5-HT2a receptor antagonists. Drugs. 2020;80(9):871-82.
19. Gottlieb M, Long B, Koyfman A. Approach to the agitated emergency department patient. J Emerg Med. 2018;54(4):447-57.
20. Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2006;45(7):771-91.
21. Greydanus DE, Agana M, Kamboj MK, Shebrain S, Soares N, Eke R, et al. Pediatric obesity: current concepts. Dis Mon. 2018;64(4):98-156.
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24. Yoon HJ, Park KM, Choi WJ, Choi SH, Park JY, Kim JJ, et al. Efficacy and safety of haloperidol versus atypical antipsychotic medi- cations in the treatment of delirium. BMC Psychiatry. 2013;13:1-11.
25. Page VJ, Ely EW, Gates S, Zhao XB, Alce T, Shintani A, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1(7):515- 23.
26. Dold M, Samara MT, Li C, Tardy M, Leucht S. Haloperidol versus first-generation antipsychotics for the treatment of schizo- phrenia and other psychotic disorders. Cochrane Database Syst Rev. 2015;(1):CD009831.
27. Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophre- nia? World Psychiatry. 2018;17(2):149-60.
28. Tranulis C, Skalli L, Lalonde P, Nicole L, Stip E. Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature. Drug Saf. 2008;31(1):7-20.
29. Chiesa A, Chierzi F, De Ronchi D, Serretti A. Quetiapine for bipolar depression: a systematic review and meta-analysis. Int Clin Psychopharmacol. 2012;27(2):76-90.
30. Nikooie R, Neufeld KJ, Oh ES, Wilson LM, Zhang A, Robinson KA, et al. Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med. 2019;171(7):485-95.
31. Oh ES, Needham DM, Nikooie R, Wilson LM, Zhang A, Robinson KA, et al. Antipsychotics for preventing delirium in hospital- ized adults: a systematic review. Ann Intern Med. 2019;171(7):474-84.
32. Kamat SS. Practical applications of mechanical ventilation. London: JP Medical Ltd; 2015.
33. Lekalakala A. Delirium in critically ill patients and its association with patient factors and outcomes in adult intensive care units [dissertation]. Johannesburg: University of the Witwatersrand; 2020.
34. Oruch R, Pryme I, Fasmer O, Lund A. Quetiapine: an objective evaluation of pharmacology, clinical uses and intoxication. EC Pharmacol Toxicol. 2020;8:1-26.
35. Carli M, Kolachalam S, Longoni B, Pintaudi A, Baldini M, Aringhieri S, et al. Atypical antipsychotics and metabolic syndrome: from molecular mechanisms to clinical differences. Pharmaceuticals. 2021;14(3):238.
36. Gusenbauer M, Haddaway NR. Which academic search systems are suitable for systematic reviews or meta-analyses? Evaluat- ing retrieval qualities of Google Scholar, PubMed, and 26 other resources. Res Synth Methods. 2020;11(2):181-217.
37. Schieveld JN, Leroy PL, van Os J, Nicolai J, Vos GD, Leentjens AF. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Med. 2007;33(6):1033-40.
38. Hatherill S. Delirium in children and adolescents. Cape Town: University of Cape Town; 2009.
39. Turkel SB, Hanft A. The pharmacologic management of delirium in children and adolescents. Pediatr Drugs. 2014;16(4):267- 74.
40. Joyce C, Witcher R, Herrup E, Kaur S, Mendez-Rico E, Silver G, et al. Evaluation of the safety of quetiapine in treating delirium in critically ill children: a retrospective review. J Child Adolesc Psychopharmacol. 2015;25(9):666-70.
41. Muneer A. Pharmacotherapy of bipolar disorder with quetiapine: a recent literature review and an update. Clin Psychophar- macol Neurosci. 2015;13(1):25-35.
42. Ketter TA, Miller S, Dell’Osso B, Wang PW. Treatment of bipolar disorder: review of evidence regarding quetiapine and lithi- um. J Affect Disord. 2016;191:256-73.
43. Cruz N, Sanchez-Moreno J, Torres F, Goikolea JM, Valentí M, Vieta E. Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis. Int J Neuropsychopharmacol. 2010;13(1):5-14.
44. Soeiro-de-Souza MG, Dias VV, Missio G, Balanzá-Martinez V, Valiengo L, Carvalho AF, et al. Role of quetiapine beyond its clini- cal efficacy in bipolar disorder: from neuroprotection to the treatment of psychiatric disorders. Exp Ther Med. 2015;9(3):643-52.
45. Yildiz A, Siafis S, Mavridis D, Vieta E, Leucht S. Comparative efficacy and tolerability of pharmacological interventions for acute bipolar depression in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2023;10(9):693-705.
46. Cheniaux E, Nardi AE. Evaluating the efficacy and safety of antidepressants in patients with bipolar disorder. Expert Opin Drug Saf. 2019;18(10):893-913.
47. Tahir TA, Eeles E, Karapareddy V, Muthuvelu P, Chapple S, Phillips B, et al. A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res. 2010;69(5):485-90.
48. Devlin JW, Roberts RJ, Fong JJ, Skrobik Y, Riker RR, Hill NS, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med. 2010;38(2):419-27.
49. Cronin MT, Di Gennaro JL, Watson RS, Dervan LA. Haloperidol and quetiapine for the treatment of ICU-associated delirium in a tertiary pediatric ICU: a propensity score-matched cohort study. Pediatr Drugs. 2021;23(2):159-69.
50. Kim K, Jeong JH, Choi EK. Non-pharmacological interventions for delirium in the pediatric population: a systematic review with narrative synthesis. BMC Pediatr. 2024;24(1):108.
51. Egberts KM, Gerlach M, Correll CU, Plener PL, Malzahn U, Heuschmann P, et al. Serious adverse drug reactions in children and adolescents treated on- and off-label with antidepressants and antipsychotics in clinical practice. Pharmacopsychiatry. 2022;55(5):255-65.
52. Du W, Ge MW, Hu FH, Jia YJ, Zhao DY, Cheng YJ, et al. QTc prolongation in patients with schizophrenia taking antipsychotics: prevalence and risk factors. J Psychopharmacol. 2023;37(10):971-81.
53. Khan Q, Ismail M, Haider I, Khan F. Prevalence of QT interval prolonging drug-drug interactions (QT-DDIs) in psychiatry wards of tertiary care hospitals in Pakistan: a multicenter cross-sectional study. Int J Clin Pharm. 2017;39(6):1256-64.
54. Rivière J, van der Mast RC, Vandenberghe J, Van Den Eede F. Efficacy and tolerability of atypical antipsychotics in the treat- ment of delirium: a systematic review of the literature. Psychosomatics. 2019;60(1):18-26.
55. Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs. 2007;21(11):911-36.
56. Hutchins LM, Shipman A, Zimmerman KO, Heath TS. Evaluation of QTc interval effects of antipsychotic medications for inten- sive care unit delirium in pediatric patients. J Pediatr Pharmacol Ther. 2020;25(1):87-91.
57. Devlin JW, Skrobik Y, Riker RR, Hinderleider E, Roberts RJ, Fong JJ, et al. Impact of quetiapine on resolution of individual delir- ium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study. Crit Care. 2011;15(5):R215.
58. Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med. 2017;45(5):891-8.
59. Ista E, Traube C, de Neef M, Schieveld J, Knoester H, Molag M, et al. Factors associated with delirium in children: a systematic review and meta-analysis. Pediatr Crit Care Med. 2023;24(5):372-81.
60. Henao-Castaño A, Monroy KN, Moreno JP, Casas EYP. Delirium in paediatrics: early detection, diagnosis and nursing care. Rev Cient Soc Enferm Neurol (Engl Ed). 2022;55:17-24.
61. Gaertner J, Eychmueller S, Leyhe T, Bueche D, Savaskan E, Schlögl M. Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care?—a critical appraisal of recent randomized controlled trials. Ann Palliat Med. 2019;8(4):504-15.
62. Maldonado J, Sher Y. Neurocognitive disorders. In: Tasman’s psychiatry. 5th ed. Cham: Springer; 2024. p. 1-60.
2. Jackson TA, Wilson D, Richardson S, Lord JM. Predicting outcome in older hospital patients with delirium: a systematic litera- ture review. Int J Geriatr Psychiatry. 2016;31(4):392-9.
3. Patel MB, Bednarik J, Lee P, Shehabi Y, Salluh JI, Slooter AJ, et al. Delirium monitoring in neurocritically ill patients: a systematic review. Crit Care Med. 2018;46(11):1832-41.
4. Ista E, Redivo J, Kananur P, Choong K, Colleti Jr J, Needham DM, et al. ABCDEF bundle practices for critically ill children: an in- ternational survey of 161 PICUs in 18 countries. Crit Care Med. 2022;50(1):114-25.
5. Sartorius N, Baghai TC, Baldwin DS, Barrett B, Brand U, Fleischhacker W, et al. Antidepressant medications and other treat- ments of depressive disorders: a CINP Task Force report based on a review of evidence. Int J Neuropsychopharmacol. 2007;10 Suppl 1:S1-207.
6. Tololeski BP, Radobuljac MD. Quetiapine treatment in pediatric scenarios. In: Diagnosis, management and modeling of neuro- developmental disorders. Amsterdam: Elsevier; 2021. p. 395-404. 7.Hatherill S, Flisher AJ. Delirium in children and adolescents: a systematic review of the literature. J Psychosom Res. 2010;68(4):337-44. 8. van Hoorn CE, Flint RB, Skowno J, Davies P, Engelhardt T, Lalwani K, et al. Off-label use of dexmedetomidine in paediatric an- aesthesiology: an international survey of 791 (paediatric) anaesthesiologists. Eur J Clin Pharmacol. 2021;77:625-35.
9. Leichsenring F, Steinert C, Rabung S, Ioannidis JP. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry. 2022;21(1):133-45.
10. Stoyanova-Beninska VV, Wohlfarth T, Isaac M, Kalverdijk LJ, van den Berg H, Gispen-de Wied C. The EU paediatric regulation: effects on paediatric psychopharmacology in Europe. Eur Neuropsychopharmacol. 2011;21(8):565-70.
11. Aronson J, La Caze A, Kelly M, Parkkinen VP, Williamson J. The use of evidence of mechanisms in drug approval. J Eval Clin Pract. 2018;24(5):1056-63.
12. Ravindran AV, Al-Subaie A, Abraham G. Quetiapine: novel uses in the treatment of depressive and anxiety disorders. Expert Opin Investig Drugs. 2010;19(10):1187-204.
13. Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychia- try. 2018;33(11):1428-57.
14. Maldonado JR. Inflammatory biomarkers and neurotransmitter perturbations in delirium. In: Delirium: acute brain dysfunc- tion in the critically ill. Cham: Springer; 2020. p. 135-67.
15. Zhu X, Feng X, Lin J, Ding Y. Risk factors of delirium in paediatric intensive care units: a meta-analysis. PLoS One. 2022;17(7):e0270639.
16. Kato T, Thie NM, Huynh N, Miyawaki S, Lavigne GJ. Topical review: sleep bruxism and the role of peripheral sensory influenc- es. J Orofac Pain. 2003;17(3):191-213.
17. Kirby J. Neurobiological bases of the use of atypical antipsychotics in treatment-resistant major depressive disorder [disserta- tion]. Ottawa: University of Ottawa; 2018.
18. Poyurovsky M, Weizman A. Treatment of antipsychotic-induced akathisia: role of serotonin 5-HT2a receptor antagonists. Drugs. 2020;80(9):871-82.
19. Gottlieb M, Long B, Koyfman A. Approach to the agitated emergency department patient. J Emerg Med. 2018;54(4):447-57.
20. Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2006;45(7):771-91.
21. Greydanus DE, Agana M, Kamboj MK, Shebrain S, Soares N, Eke R, et al. Pediatric obesity: current concepts. Dis Mon. 2018;64(4):98-156.
22. Liviskie C, McPherson C, Luecke C. Assessment and management of delirium in the pediatric intensive care unit: a review. J Pediatr Intensive Care. 2023;12(2):94-105.
23. Schrijver EJ, de Graaf K, de Vries OJ, Maier AB, Nanayakkara PW. Efficacy and safety of haloperidol for in-hospital delirium pre- vention and treatment: a systematic review of current evidence. Eur J Intern Med. 2016;27:14-23.
24. Yoon HJ, Park KM, Choi WJ, Choi SH, Park JY, Kim JJ, et al. Efficacy and safety of haloperidol versus atypical antipsychotic medi- cations in the treatment of delirium. BMC Psychiatry. 2013;13:1-11.
25. Page VJ, Ely EW, Gates S, Zhao XB, Alce T, Shintani A, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1(7):515- 23.
26. Dold M, Samara MT, Li C, Tardy M, Leucht S. Haloperidol versus first-generation antipsychotics for the treatment of schizo- phrenia and other psychotic disorders. Cochrane Database Syst Rev. 2015;(1):CD009831.
27. Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophre- nia? World Psychiatry. 2018;17(2):149-60.
28. Tranulis C, Skalli L, Lalonde P, Nicole L, Stip E. Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature. Drug Saf. 2008;31(1):7-20.
29. Chiesa A, Chierzi F, De Ronchi D, Serretti A. Quetiapine for bipolar depression: a systematic review and meta-analysis. Int Clin Psychopharmacol. 2012;27(2):76-90.
30. Nikooie R, Neufeld KJ, Oh ES, Wilson LM, Zhang A, Robinson KA, et al. Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med. 2019;171(7):485-95.
31. Oh ES, Needham DM, Nikooie R, Wilson LM, Zhang A, Robinson KA, et al. Antipsychotics for preventing delirium in hospital- ized adults: a systematic review. Ann Intern Med. 2019;171(7):474-84.
32. Kamat SS. Practical applications of mechanical ventilation. London: JP Medical Ltd; 2015.
33. Lekalakala A. Delirium in critically ill patients and its association with patient factors and outcomes in adult intensive care units [dissertation]. Johannesburg: University of the Witwatersrand; 2020.
34. Oruch R, Pryme I, Fasmer O, Lund A. Quetiapine: an objective evaluation of pharmacology, clinical uses and intoxication. EC Pharmacol Toxicol. 2020;8:1-26.
35. Carli M, Kolachalam S, Longoni B, Pintaudi A, Baldini M, Aringhieri S, et al. Atypical antipsychotics and metabolic syndrome: from molecular mechanisms to clinical differences. Pharmaceuticals. 2021;14(3):238.
36. Gusenbauer M, Haddaway NR. Which academic search systems are suitable for systematic reviews or meta-analyses? Evaluat- ing retrieval qualities of Google Scholar, PubMed, and 26 other resources. Res Synth Methods. 2020;11(2):181-217.
37. Schieveld JN, Leroy PL, van Os J, Nicolai J, Vos GD, Leentjens AF. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Med. 2007;33(6):1033-40.
38. Hatherill S. Delirium in children and adolescents. Cape Town: University of Cape Town; 2009.
39. Turkel SB, Hanft A. The pharmacologic management of delirium in children and adolescents. Pediatr Drugs. 2014;16(4):267- 74.
40. Joyce C, Witcher R, Herrup E, Kaur S, Mendez-Rico E, Silver G, et al. Evaluation of the safety of quetiapine in treating delirium in critically ill children: a retrospective review. J Child Adolesc Psychopharmacol. 2015;25(9):666-70.
41. Muneer A. Pharmacotherapy of bipolar disorder with quetiapine: a recent literature review and an update. Clin Psychophar- macol Neurosci. 2015;13(1):25-35.
42. Ketter TA, Miller S, Dell’Osso B, Wang PW. Treatment of bipolar disorder: review of evidence regarding quetiapine and lithi- um. J Affect Disord. 2016;191:256-73.
43. Cruz N, Sanchez-Moreno J, Torres F, Goikolea JM, Valentí M, Vieta E. Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis. Int J Neuropsychopharmacol. 2010;13(1):5-14.
44. Soeiro-de-Souza MG, Dias VV, Missio G, Balanzá-Martinez V, Valiengo L, Carvalho AF, et al. Role of quetiapine beyond its clini- cal efficacy in bipolar disorder: from neuroprotection to the treatment of psychiatric disorders. Exp Ther Med. 2015;9(3):643-52.
45. Yildiz A, Siafis S, Mavridis D, Vieta E, Leucht S. Comparative efficacy and tolerability of pharmacological interventions for acute bipolar depression in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2023;10(9):693-705.
46. Cheniaux E, Nardi AE. Evaluating the efficacy and safety of antidepressants in patients with bipolar disorder. Expert Opin Drug Saf. 2019;18(10):893-913.
47. Tahir TA, Eeles E, Karapareddy V, Muthuvelu P, Chapple S, Phillips B, et al. A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res. 2010;69(5):485-90.
48. Devlin JW, Roberts RJ, Fong JJ, Skrobik Y, Riker RR, Hill NS, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med. 2010;38(2):419-27.
49. Cronin MT, Di Gennaro JL, Watson RS, Dervan LA. Haloperidol and quetiapine for the treatment of ICU-associated delirium in a tertiary pediatric ICU: a propensity score-matched cohort study. Pediatr Drugs. 2021;23(2):159-69.
50. Kim K, Jeong JH, Choi EK. Non-pharmacological interventions for delirium in the pediatric population: a systematic review with narrative synthesis. BMC Pediatr. 2024;24(1):108.
51. Egberts KM, Gerlach M, Correll CU, Plener PL, Malzahn U, Heuschmann P, et al. Serious adverse drug reactions in children and adolescents treated on- and off-label with antidepressants and antipsychotics in clinical practice. Pharmacopsychiatry. 2022;55(5):255-65.
52. Du W, Ge MW, Hu FH, Jia YJ, Zhao DY, Cheng YJ, et al. QTc prolongation in patients with schizophrenia taking antipsychotics: prevalence and risk factors. J Psychopharmacol. 2023;37(10):971-81.
53. Khan Q, Ismail M, Haider I, Khan F. Prevalence of QT interval prolonging drug-drug interactions (QT-DDIs) in psychiatry wards of tertiary care hospitals in Pakistan: a multicenter cross-sectional study. Int J Clin Pharm. 2017;39(6):1256-64.
54. Rivière J, van der Mast RC, Vandenberghe J, Van Den Eede F. Efficacy and tolerability of atypical antipsychotics in the treat- ment of delirium: a systematic review of the literature. Psychosomatics. 2019;60(1):18-26.
55. Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs. 2007;21(11):911-36.
56. Hutchins LM, Shipman A, Zimmerman KO, Heath TS. Evaluation of QTc interval effects of antipsychotic medications for inten- sive care unit delirium in pediatric patients. J Pediatr Pharmacol Ther. 2020;25(1):87-91.
57. Devlin JW, Skrobik Y, Riker RR, Hinderleider E, Roberts RJ, Fong JJ, et al. Impact of quetiapine on resolution of individual delir- ium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study. Crit Care. 2011;15(5):R215.
58. Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med. 2017;45(5):891-8.
59. Ista E, Traube C, de Neef M, Schieveld J, Knoester H, Molag M, et al. Factors associated with delirium in children: a systematic review and meta-analysis. Pediatr Crit Care Med. 2023;24(5):372-81.
60. Henao-Castaño A, Monroy KN, Moreno JP, Casas EYP. Delirium in paediatrics: early detection, diagnosis and nursing care. Rev Cient Soc Enferm Neurol (Engl Ed). 2022;55:17-24.
61. Gaertner J, Eychmueller S, Leyhe T, Bueche D, Savaskan E, Schlögl M. Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care?—a critical appraisal of recent randomized controlled trials. Ann Palliat Med. 2019;8(4):504-15.
62. Maldonado J, Sher Y. Neurocognitive disorders. In: Tasman’s psychiatry. 5th ed. Cham: Springer; 2024. p. 1-60.
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Is Quetiapine Safe and Effective for Pediatric ICU Delirium? AReal-World Meta-Analysis. Pharm Pract (Granada) [Internet]. 2026 Jun. 20 [cited 2026 Jun. 21];24(2):1-22. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3261
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How to Cite
1.
Is Quetiapine Safe and Effective for Pediatric ICU Delirium? AReal-World Meta-Analysis. Pharm Pract (Granada) [Internet]. 2026 Jun. 20 [cited 2026 Jun. 21];24(2):1-22. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3261